About the author: I am a final year medical student. I wrote a number of articles to counter the massive amount of misinformation I have come across. The information outlined below took years of research, experimentation, engineering, and modifying. Had I known then what I know now, it would have saved me a vast amount of time, money, effort, and suffering. Here I share with you some things I have learned along the way.
This guide discusses safe, effective, physiological hormone replacement. It covers a wide array of topics including benefits, risks, side effects, blood tests, symptoms, ethical issues, products, therapy of choice, dosages, doctors, costs, and sources. It is suitable for males and females alike.
For several years I have been using natural, bioidentical hormones (testosterone, thyroid, cortisol, growth hormone) to bioengineer my health, body, and mind. Hormone optimization gave me my life back, and it can do the same for you.
Hormones have a considerable impact on our energy, mood, and health. So, in a way, hormones determine the quality of our lives. Sadly, many of us have hormonal imbalances.
Unfortunately, good hormone specialists are incredibly rare and very hard to find. Subspecializations in medicine have produced doctors who are often unable to detect even blatant signs of hormone deficiencies, which causes great suffering. They claim nothing is wrong with us. They give us stimulants, antidepressants, suggest psychotherapy, and/or send us somewhere else.
Few comprehensive information sources about hormones are available. However, there is a lot of misinformation. That is why I wrote this guide. Having learned a lot along the way, I want to share the most important findings with you. Many of the facts, tips, tricks, cannot be found anywhere else.
Our goal is to achieve optimal energy levels, mood, and health. At baseline. This does not mean taking stimulants, being productive for a few hours, then crashing. We are in for the long game, a marathon, not a sprint.
While there are some performance-enhancing aspects to even physiological hormone replacement, please note that the primary focus of this guide is not on performance enhancement (e.g. bodybuilding, doping, etc.), but rather on safe, effective, physiological, and sustainable hormone optimization that can be applied throughout our lifetime and is focused on health, disease prevention, longevity, and self-optimization.
Article structure explained
This article is divided into two parts.
In Part I you will learn about the importance of hormones and why they can both destroy and save your life. You will get to know about hormones’ importance in energy levels, mood, health, longevity, and why they are a powerful tool to cure depression, anxiety, fatigue, and many other ailments that plague large parts of society. You’ll learn why hormones are mostly neglected by mainstream medicine, how many of the rich and powerful are using hormones extensively for their own benefits, and why there are risks and dangers of being left behind.
Part II is mostly practical. I lay out my own hormone optimization protocol and describe some of the changes I have noticed over the years. Then you will learn about many practical aspects of hormone optimization (e.g. how to improve hormones naturally, what to test for, how to interpret blood tests, how to get started, how to find a good doctor, dosages, balancing hormones, etc.). Then you will learn more details about how to replace the individual hormones (thyroid hormones, cortisol, testosterone, female sex hormones, growth hormone).
PART I (general part)
Section 1. Hormones can destroy and save your life.
Section 2. Hormones: physical and mental health
Section 3. Hormones: an unknown superpower
Section 4. Is hormone replacement unnatural? Is it cheating?
Section 5. Should you replace your hormones?
PART II (practical part)
Section 6. How I optimize my hormones
Section 7. How to improve hormones naturally
Section 8. General and practical aspects of hormone optimization
(how to get started, blood tests, what to test for, the dangers of blood tests, reference ranges, finding the right doctor, sources, costs, balancing hormones, individual differences, how to start therapy, tolerance, stopping hormone therapy)
Section 9. How to replace hormones
Section 10. Risks & side effects
Section 11. Will I have to continue hormone therapy for life?
1. Hormones can destroy and save your life.
My whole life I have been quite happy. Curious, well-rounded, and sociable. Around the age of 20, this all began to change. I felt awful all the time. Always lethargic. I felt cold all the time. It took me forever to wake up. I became slow in thought and could not concentrate. I felt dumb. Everything required a ton of self-discipline. I just wanted to stay by myself. My mood was always bad. Rarely did I laugh. No magic in life. No butterflies.
After each day I was relieved that another day was over. I was at best just trying to get by.
My social life deteriorated. I started to neglect friends, became negative, judgmental, irritable, withdrawn. My life went down the gutter and I became a pale semblance of my former self.
I attributed it to weakness and bad lifestyle choices. I pulled myself out of this pit far enough to lead a good lifestyle in terms of sleep, diet, exercise, etc. However, I still felt like crap and, quite frankly, sick of everything.
For a long time, I was unaware of the powerful but invisible forces I was up against. Being a medical student I ran some tests. I found out that multiple of my hormones were rock-bottom.
This gradual drop in my hormones eroded many things I held dear. My wellbeing, my personality, my relationships, my education, my life. I started to replace what was missing. Whereas the start was rocky, within a few years of trial & error I got my life back. As my hormones improved, many other facets of my life automatically started to improve as well.
I realized how much easier and enjoyable life gets if I have great energy levels, mood, and health all the time. The upwards spiral started again. An upwards spiral that otherwise would have never happened.
From now on I was not always tired anymore. I had more energy after waking up and felt more optimistic about starting a new day. I again had more drive to do things and was more motivated to study.
With improved energy, drive, and motivation my willpower increased. I made better food choices, exercised more, and slept better.
Thanks to hormones’ direct effects on muscle, fat, skin, hair, etc., I began to look better. The gains in looks, self-confidence, energy, mood, and zest for life, improved my social life. I had more self-confidence to approach people. Whereas before I was an anhedonic hermit, now I wanted to go out. I enjoyed being around others and because energy levels and mood are contagious, others enjoyed my company as well. Instead of an irritable asshole on autopilot, I was now much more present.
Over time I became different. No further knowledge or “insight” was required. No self-help books or painstaking habit formation, which lead to slow and unreliable progress at best anyway.
Of course, all this did not happen overnight, but rather over long periods of time (months to years) due to many complex and cross-interacting feedback loops spanning all domains of my life. However, slowly but surely, my new-found, above-average vitality gave me value on a daily basis, which was automatically reinvested. Each day anew, 7 days a week, 365 days a year. Compound interest is the most powerful force in the universe.
What about my happiness? Life is just as good as our mind is. However, the mind is what the brain does. And it turns out that hormones have a major say in what our brain does.
Therefore, optimizing my hormones certainly made me feel better from a biochemical perspective. Because with better energy and mood, all else being equal, I feel better at every given moment. Right now. And given that my life is simply a string of single moments, my area-under-the-curve happiness increases. However, independent of any neurobiochemical effects, I also felt better about myself and my life in general because many “objective” facets of my life improved as well (e.g. status, looks, career, social life, love life).
Furthermore, I became a healthier, happier, and more productive individual. This benefitted not only my outer and inner life but since I will directly and indirectly touch the lives of many other people, it will enable me to be a better contributor to humanity as well.
Altering, tweaking, and optimizing hormones was a long journey. It took years of studying, testing, experimenting, trial & error, repeat. However, it was worth it. As I improved my hormonal balance, both my inner life (subjective wellbeing) and my outer life (objective life situation) have radically improved.
Even though I did all of this pretty much myself, I am well aware that in many respects I had been quite lucky (e.g. What if I were born 20 years earlier? What if I did not make it to med school?) For a more in-depth version of how hormones destroyed and saved my life, read: How Hormones Destroyed And Saved My Life -From The Brink Of Suicide To Bliss.
Life is like poker — vitality is your ace
Many people with great conventional life success such as politicians, actors, CEOs, athletes, etc. often credit their accomplishments and high-tier place in society to their intelligence, effort, perseverance, talent, grit.
For them it feels natural to believe they deserve it, looking down upon “the lazy masses” binging Netflix, eating a crappy diet, consuming without creating, never opting for the hard things but rather being complacent in their comfortable rut of the status quo. From their perspective, living a life of quiet desperation.
But what were the conditions that led to their intelligence, effort, perseverance, talent, and grit in the first place?
They are often unaware of the luck they had. There is an innumerable number of conditions completely outside their influence that enabled them to work hard in the first place. From being born in a prosperous country, schooling, race, looks, caring parents who were cherishing and motivating along the way, many more.
However, great vitality is on average the most important factor that determines the trajectory and success of most people’s lives (e.g. status, wealth, relationships, happiness).
Google defines “vitality” as “the state of being strong and active”. For the sake of this article we will define vitality as a catch-all-term encompassing three things (which are all intricately linked):
- Energy levels
Vitality is first and foremost determined by three things. Genetics (which as of yet we cannot negotiate), lifestyle (sleep, diet, exercise), and hormones. However, many -but not all- effects of genetics and lifestyle are indirectly mediated through the way they affect our hormones. Around two-thirds of our vitality directly comes from our hormones -regardless of whether hormone levels are caused by genetics, age, lifestyle-induced, or replacement therapy.
Life is like poker. We can get a good hand, play it perfectly, but still end up with a bad outcome. Great vitality is our ace in the game of life. Even with an immaculate vitality, we can screw up the game, but chances are we do so much less likely.
If we feel tired, unmotivated, moody all the time, making our only life a great life is just not on the cards. Our energy levels, mood, health, motivation, looks, concentration, memory, cognition, recovery, etc. -all affect us every day. All these depend to a significant extent on our hormones. If our hormones are not balanced, success in other parts of our life will often be elusive.
Imagine you had your best, most vital hour of the day extended to the entire day. 7 days a week. 365 days a year. How much more productive could you be? Where would your life be in 10 years from now (psychologically, physiologically, financially, socially, intellectually)? How much more could you enjoy your time? How much more could you contribute to the well-being of others? Compound interest. The earlier we start, the exponentially more return we get.
Those lucky enough to have been bestowed upon with a great vitality (e.g. great genetics), by the age of 20, are on average much further ahead compared to most of us who are not significantly regressing from the mean. If we were to perform a multivariate regression analysis to determine the factors that correlate with a “great” life (success, status, wealth, relationships, happiness, etc.), we would find a strong correlation with vitality. In fact, vitality likely has a stronger correlation than all others.
Whatever we want in life, whether that is creating, contributing, achieving a specific goal, or simply living life to the fullest, great vitality is the most important requirement to get us there.
Are you aware of your baseline?
Last year I did a 5-day fasting-mimicking diet. While I felt great for the first three days, I got very lethargic and brain-foggy on day four. I was more or less incapacitated. Neither had I the capacity nor the motivation to do anything. My work efficiency was perhaps one third compared to what it normally is. And life enjoyment was much less.
This temporary state reminded me of how I felt only a few years ago all the time. Always lethargic, moody, and unmotivated. If you feel like this day in and out, how can you get anywhere in life?
Think about the last time you were sick. Remember how much less productive you were, how much more energy everything took you, how much less enjoyable life was.
Fortunately for most of us, these periods just happen occasionally and after a few days, they pass and are quickly forgotten. But now let’s assume this state would continue for a whole year. How much would this impact your life? How much less would you accomplish? How much less could you enjoy things, people, or life?
But what about when you are not sick? Most of us are not aware of what our baseline is. Other than the temporary boost with stimulants, most of us have no idea how much better (or worse) we could feel and function. Because we simply do not know anything else, we do not know how we feel on a daily basis compares to the way others do. The days you feel your best might be someone else’s baseline. Your worst days (e.g. bad night of sleep, sickness) might be somebody else's best days. Your best and most productive hour of the day might be how someone else feels most of the time.
There is a reason why most people have their prime vitality from 18 to 30. Around this time, their hormonal profiles are at their best, and therefore they experience their biological heyday. Lots of energy. Brain performance is at its peak. They look their best and are their healthiest. Many can even eat whatever they want while still staying “lean and mean”. As people get older, they start to lose excitement for life and performance begins to suffer. The body visibly ages and people become less fit.
If you are in your forties or beyond, imagine you could relive a single day when you were 20. The difference in how you feel and function would be like night and day, akin to cleaning dusty glasses for the first time in years. You would likely start to question your current baseline. How perhaps it might have been holding you back for years, without you being aware. And the main reason was the progressive age-related decline in your hormones, which was too gradual for you to notice.
Maintaining great vitality for decades after our physiological peak is just impossible without the use of hormone replacement, at least for most of us. By restoring our hormones to youthful levels, we can approach and recreate the state of health, performance, and wellbeing we once enjoyed (and perhaps we can even do better).
Let’s say in a futurist, high-tech virtual-reality console with a perfect computer-brain-interface-integration, you could adjust hormone levels how you want. You can then live with different customized hormonal profiles for a few days to try out what it would be like.
If your newly combined constellation of hormones were “much better” compared to what you are used to in real life, you would realize that many of the problems you struggle with on a daily basis would be gone. From not being able to fall asleep, taking forever to get ready after waking up, feeling tired, feeling unmotivated, procrastinating, being depressed, having brain fog, experiencing an afternoon lull, struggling to lose weight, having little confidence in interactions, etc.
After having seen the other side, quite likely you would not want to go back. However, if your engineered hormonal profile were “much worse”, you would likely conclude that although hormones might not be everything, without them, everything is nothing. You would likely also develop deep compassion and understanding for people occupying places in society towards the bottom of conventional life success.
Well, I have done this virtual-reality thought experiment in real life. I have been both low and high in every major hormone in many different constellations. Tweaking my hormones on a monthly and sometimes even weekly basis, I was shown how much our baseline state is determined by our levels of hormones at any given point in time. I have experienced how much it can be changed and after having seen the “much better”, of course I did not want to go back.
2. Hormones and physical and mental health
Hormones affect the whole body.
Note: For more info: The Science Of Hormones -An Unconventional Introduction
Life consists of cells. Cells are biological machines emerging from the laws of chemistry and physics and just do what they are programmed to. The blueprint for this program is written in form of the genetic code. Hormones act on this code directly. By directly affecting gene expression, hormones are one of the main factors that determine what programs -and to what extent- are running in any given cell at any given point in time.
Every single cell in our body has a receptor for all of these four major hypothalamic hormones. Each of them unlocks a specific portion of the genetic code, depending on what part of the code is accessible -which differs between tissues.
Therefore, each of the major hormones affects every single cell in our body in a certain way directly. However, each hormone also affects many other hormones, mediators, liver, kidney, immune system, heart, other organ systems, metabolism, lifestyle choices, etc. all of which then affect every single cell in our body in many ways indirectly as well.
Hence, by adding or tweaking hormones, we interfere directly with the genetic code our cells express. We intervene at the most downstream level possible (gene expression). We are sending whole-body messages to all of our cells and it is now us who is telling our cells how to behave. Furthermore, we also affect our entire body in many second and third-order ways indirectly. Long story short, hormones affect everything -our energy levels, mood, motivation, sleep, metabolism, cognition, etc. This is what makes hormones uniquely powerful -far more powerful than taking a pharmaceutical drug merely affecting a single target.
If things go wrong with even just one of our major hormones this will have major consequences because every hormone has system-wide effects: genome → cell → tissue → organ → organ system → physiology → behavior → life.
Certainly in my life, the malfunction of this tiny part in my brain that controls our four major hormones has wreaked a ton of havoc on many levels. I am certain the same holds for many others as well, even though most will likely never be aware of it.
From what I have seen, I guess that around 1 in 5 people have a hormonal imbalance severe enough to warrant intervention.
There are millions of people worldwide who, for years, have been living in states of pitiful energy, mood, and health. Chronically lethargic, unmotivated, depressed, sick. For many of them, hormonal problems are the root cause, which causes life to be much harder, less enjoyable, less healthy compared to how it could be.
When it comes to health-improvement, all the focus is on diet, sleep, exercise, gut health, pharmaceutical drugs, supplements. All of them are billion-dollar industries. While all of these are important, one simply cannot “out-drug” or “out-lifestyle” a bad hormonal profile. Too bad most people do not know much about hormones.
While, diets, exercise, sleep, stress reduction, connection with others, are all important for living a long and healthy life, few things have as profound of an impact as restoring hormones to optimal levels. Ensuring a good hormonal profile, whether through natural means or not, is by far the most important and potent health and life-improvement there is. It affects everything else.
Hormones and mental health
Just as hormones play a role with any other bodily system, they also play a major role in the health and function of our nervous system and consequently, a good hormonal balance is crucial for mental health.
In this section, we are going to focus specifically on mental health because firstly, mental health issues are ubiquitous, and secondly, without mental health, nothing else matters. Mental health is the strongest individual predictor of life satisfaction and given that the mind is all we have, mental illness can take away our lives (not just literally). Mental illness does not only make the only thing that is truly ours -our mind- a painful place to be but lasting clinical depression or anxiety usually also wreaks havoc on many objective domains of our life (e.g. health, relationships, career).
In general, about half to one-third of people have a diagnosable mental illness, the most common of which perhaps are anxiety and depression. Almost everyone is affected by either one of these at least at some point in their life. They are among the most common complaints communicated to doctors and psychiatric drugs for these conditions are among the most prescribed drugs on the planet.
However, often these drugs just patch up symptoms. In fact, every major hormone deficiency can cause depression, anxiety, and fatigue. If someone is hormone-deficient, antidepressants or anxiolytics usually work just suboptimally. After hormone levels are adequately restored, many patients are able to get off psychiatric drugs even though they once thought there is no way they could live without them.
For more background about my brief encounter with suicide and what I learned from it, read here: Why depression is a chemical imbalance but not the way you think. Lessons from MDMA, bipolar disorder, self-experiments.
Certainly not every mental illness is due to hormone deficiencies. It is possible that someone is legitimately depressed or anxious, despite hormones being great. Perhaps you have lost something or someone. Perhaps you have some trauma you cannot come to terms with. Perhaps you are procrastinating all the time because you just have not found anything to be passionate about. Life is simply too short and precious to be suffering for long periods of time.
So, if lifestyle changes and psychotherapy do not bring about adequate relief, some people will have to resort to an antidepressant, anxiolytic, or stimulant drug and the side effects of these drugs need to be weighed against the side effects of potentially having a miserable life. Nevertheless, it would not hurt to at least look at hormones first, which are much more “natural” than the psychiatric drugs our societies are fattened up with. Unfortunately, rarely are hormones viewed as contributing causes, rarely are their levels adequately checked for by doctors, and rarely are rarely used as a treatment. Consequently, millions of people unnecessarily suffer for it. What a waste of happiness and potential.
Hormones and happiness
Science claims happiness to be determined to 50–80% by genetics. This has been concluded in multiple, independent studies by continuously sampling the happiness-level of monoecious twins separated at birth (to correct for any non-biological factors). This means that for the average human being, biological factors are more important than all the other factors combined.
And in terms of our biological factors, nothing is as important as our hormonal profile. They not only determine how our “objective” life turns out but also our degree of subjective happiness. However, the effects are, to some extent, indirect. Hormones do not only affect our moment-to-moment well-being (the way we “feel” on a daily basis) but also our thinking patterns, the way we act, the way we look, and therefore our life overall: relationships, wealth, relationships, status, profession, etc. - which all have independent effects on our happiness levels.
Hormones determine the evolution of our path through life from very early on. It starts with in-utero levels of hormones. For example, if the mother’s cortisol levels had been high throughout pregnancy, the cortisol crosses the placenta and acts on developing neural networks associated with the fear and stress response and by influencing cytoarchitecture in the amygdala -among other things- massively influences the child’s risk for developing depression and anxiety down the line.
There is a reason that males with low testosterone are three times more likely to develop depression. This does not only depend on how they feel on a daily basis but, over time, the low testosterone indirectly affects many aspects of their life, from energy and mood, thinking patterns, personality traits, relationships, status, looks, income, all of which are important on their own. Therefore, while testosterone does directly influence mood, its connection to depression is not as “direct” as it might seem but mediated to a large extent through all the effects low/high levels of testosterone have on an individual’s life situation.
There is a reason why over half of the women in Western countries above the age of 65 are on antidepressants, an increase of 50% compared to before menopause. Why do depression and anxiety skyrocket with menopause? Why do many more female suicides happen during the first 7 days of their menstrual cycle?
Hypothyroidism results in similar numbers. Thyroid hormones, the most prescribed drug on the planet, are powerful antidepressants, often far more potent than any synthetic alternative.
Any hormone deficiency causes general fatigue and tiredness in anyone affected. A deficiency in any of the four major hormones is associated with depression, which usually improves drastically after correction. Furthermore, a deficiency in sex hormones often leads specifically to insomnia and anxiety.
Getting hormones in order can certainly help with many forms of mental illness. Firstly, due to hormones‘ effects on mood and wellbeing, they directly influence how we feel and think and therefore affect our thinking patterns and mental state in major ways. Secondly, they give us the requisite vitality to tackle whatever needs to be tackled.
3. Hormones: an unknown superpower
Why hormones are neglected by mainstream medicine
We live in an era of evidence-based medicine. The lion’s share of this evidence comes from the pharmaceutical industry and the driving force behind any industry is revenue generation.
However, hormones are natural molecules designed by nature and not by laboratory ingenuity. This means that they cannot be patented and therefore not much money can be made from them. Consequently, there is no financial incentive for big pharmaceutical companies to pump millions of dollars into the large, well-designed, and ultra-expensive randomized clinical trials necessary for gathering evidence. As a result, when it comes to hormones, the evidence is often lacking.
Thus, even though the absence of evidence is not evidence of absence, most doctors do not commonly focus on hormones as much as they should. Most doctors limit hormone usage to melatonin, vitamin D, thyroid treatment, and perhaps some (inadequate) replacement of female sex hormones to reduce postmenopausal symptoms. Because hormonal decline upon aging contributes massively to a host of chronic diseases, mental health issues, and deaths, this limited use of hormone therapies has huge societal, economic, and personal costs.
Why hormones are neglected by mainstream medicine the way they are, is beyond me. Hormones affect everything. By acting at every single cell in our body, they have potent effects on systemic health directly. Also, by affecting many different organs, tissues and countless other signaling molecules (all of which have their own ramifications on our health), they have a powerful influence on systemic health indirectly. Furthermore, by having a major impact on our energy levels, mood and wellbeing they have a mighty say in the lifestyle we lead, which has a major effect on our health all by itself (e.g. most of our modern, chronic diseases are to a large extent lifestyle-induced). Given this, from a financial perspective, paying for hormonal therapies would be a great economical decision for the government. Firstly, there would be a direct cost reduction because many individuals would likely need fewer health-care resources down the line (e.g. chronic diseases, burnout, caretaking, etc.). Secondly, there would be large indirect gains from having a more healthy, more functional, and more productive workforce (e.g. an increase in production, innovation, taxes, etc.)
Hormones are all about prevention.
The entire healthcare system is mostly geared towards helping us live longer once we contract a disease. Thus, it could be argued that we do not have a system of “health care” but rather a system of “sick care”, meaning that we only interact with our healthcare system once there is a problem.
Capitalism is the framework upon which the comfortable and sumptuous lifestyles most of us enjoy is built. However, this whole system relies upon the machinery of economic growth as its engine, powered by financial incentives. This drives innovation and progress with the ultimate goal of revenue generation. A cycle where prevention of disease, and thus prevention of revenue, has no place.
If mainstream medicine put a greater emphasis on the prevention of disease, who would then consume all these prescription drugs that make us “healthy” again? Usually, patients take more than one at a time. People over 60, on average, take six or more prescription drugs on a regular basis.
Pharmaceutical drugs certainly are not “bad”. However, their final effect is in most cases far too narrow and unspecific. Because the effects of most drugs are usually very high upstream in the signaling hierarchy, they often just treat the symptoms, not the causes.
On the other hand, hormone therapies are often able to eliminate many ailments and symptoms simultaneously. From helping with weight loss, decreasing blood pressure, promoting metabolic health (blood lipids, blood glucose, nutrient partitioning, insulin resistance, etc.), preventing osteoporosis and Alzheimer’s, improving mental health (ADHD, depression, anxiety, fatigue, fibromyalgia…), ameliorating chronic pain, etc.
Hormones are molecules our bodies have been adapted to for millions of years. Hormones are not just among the most “natural” therapies we have. They are also among the most holistic therapies we have because hormones affect every single one of our cells directly (and indirectly). They truly concern the whole body and mind, the whole human being. Hormone optimization is all about prevention and longevity. It is about healthy, high-quality years lived, not just total lifespan.
The use of hormone therapy is no secret and a few doctors around the world have recognized its unparalleled power. These doctors are often practitioners of functional medicine, whose main focus is on prevention and targeting the root causes instead of using cocktails of multiple prescription drugs to patch up symptoms.
These doctors use hormones extensively and have been doing so for decades in thousands of patients. They often balance multiple hormones using small physiological dosages. There certainly are risks (as there are with any other therapy) but they found that, in most cases, if done well, the risk is small and vastly outweighed by the benefits.
However and unfortunately, due to this lack of funding, there is not much good clinical evidence for the use of hormone therapies in the same way there is for industry-promoted pharmaceutical drugs. Therefore, they can get sued and/or lose their license if something goes wrong. Hence, these doctors often practice in the background, largely outside the established medical system, and predominantly serve the rich and powerful.
The danger of being left behind.
Individual biological limits have always been strong determinants of life success.
Energy, mood, health, motivation, focus, etc. majorly depend on our biochemistry. These will affect someone’s performance in school, drive, the ability for sustained attention, confidence, charisma, and so on. Down the road, these biologically determined traits will affect someone’s social and economic standing in major ways.
Therefore, ever since humans have been accumulating wealth, biological inequality was a major contributing factor to social and economic inequality. However, for the first time in human history, people can now stretch and even transcend these biological constraints.
If someone improves these biologically determined traits at any point in life, they will get physiological, psychological, intellectual, social, financial value out of it every day. A value they can reinvest, day after day. Compound interest. The earlier they start, the more compound return they get.
Many people do this already. Unfortunately, these are mostly people already high up on the socioeconomic ladder. They have access to “high-tier”, personalized medicine focused on “enhancing” rather than “repairing”. Multiple hormone replacement therapy is one of the most fundamental pillars of modern anti-aging medicine, usually reserved for the rich and powerful.
Consequently, social and economic inequality furthers biological inequality, which then increases socioeconomic inequality even more. Over time, this leads to widening wealth disparity. Given the capacities of modern medicine for bio-enhancement, one should seriously worry about the emergence of two biological classes a few decades down the line because breakthroughs in health and performance enhancement generally cascade like this: elite athletes & scientists → rich people → the rest of us. The last jump from the rich to the general public can take 10–20 years, if it happens at all — it often does not. The future is already here. It is just unevenly distributed.
For example, my dad is a self-employed lawyer. In his mid-forties, his energy and motivation began to wane. He gained weight and his work performance started to suffer. I put my dad on testosterone replacement, restoring his sex hormones to youthful levels. In the first year, his income rose by about 30%.
4. Is hormone replacement unnatural?
Our mental and physical operating system is outdated.
You are sitting here reading this on an electronic device while data is being streamed to you with the speed of light via a fiber optic cable connected to a source of electromagnetic radiation. In this respect, what does “natural” even mean?
Evolution adapted our endocrine system -along with our genetic, biochemical, physiological machinery- to a completely different world. Because our endocrine system has evolved for different times, it is not adapted to the modern environment we currently live in (e.g. artificial lightning, combinations of high-fat and high-sugar and highly processed foods, fast-spiking carbohydrates, sedentary lifestyles, living beyond the age of 40, ever-present low-level stress, intense schedules, loneliness, large social networks, a requirement for constant mental alertness, altered circadian rhythm, etc.). This makes our physiological operating system outdated.
Therefore, our endocrine system abounds with “evolutionary mismatches” and this same system now responds to these modern, unnatural conditions in often maladaptive ways. Counter-regulating in an “unnatural” way is just as “unnatural” as is living in our unnatural modern world in the first place. By using targeted interventions, all we would do is update our endocrine system to be more suited to these new, unnatural conditions. In fact, this is what updates are for. If some upgrading happened along the way, I personally do not mind.
Note: We as a species got this far because we were never accepting of the conditions thrown at us but have been engineering these conditions to our liking. Otherwise, we would still be in the trees, not even in the caves. Now, for the first time in history, we can think about engineering ourselves around the biological limits if we choose to do so. However, I can also see the other side or this argument -and I do respect it.
Our bodies were never intended to live beyond the age of 40.
We live in a society where we value living beyond our natural years. Then why are we condemning things that are “unnatural”? It is an asinine argument to me.
Homo sapiens’ reproductive success was mostly determined before the age of 40. Before this age, our bodies were made to be full of energy and health. However, they were not made for being healthy and well-functioning much beyond this age because there have never been the necessary evolutionary pressures for it.
As we surpass the lifespan we evolved for, among many other degenerative processes, our hormone levels naturally decline across the board. However, in the same way our bodies were never made for being this old, they were also not made for being in this state of multiple hormone deficiency for decades. Replacing what is now missing is not just healthier than not doing so, it is also just as unnatural as is living beyond the age of 40 in the first place.
Is hormone optimization cheating?
Keeping my hormones where I feel and function best, gives me a significant advantage in life across many areas. Everything is a lot easier now. Therefore, in my early days of hormone replacement, I felt like a cheater.
Cheating is defined as “to act unfairly to gain an advantage”. Hormone replacement certainly does give someone an (unfair?) advantage and therefore could be labeled as cheating. However, since energy, mood and health are certainly unfairly distributed, there was never a fair playing field to begin with. People with naturally above-average vitality are disproportionately overrepresented in higher socioeconomic positions, for which there certainly seems to be a natural selection. Besides, not everyone in these positions is (or remains) “natural”.
For example, the use of smart drugs is rampant in every professional domain and the use of performance-enhancing drugs is ubiquitous in sports. While this is widely known, most are unaware that extensive hormone replacement is leveraged by many of the people in the top tiers of society, from CEOs, politicians, sportsmen, doctors, actors, etc. People admitting to using hormones are very few because they like to be seen as “genetically gifted” (Some prominent examples include John F. Kennedy and Joe Rogan.)
Even if you do not believe in “enhancing” yourself because it is “cheating”, many others simply do not share your beliefs. People you compete against might not shy away from cheating because of ethics.
Even though hormone optimization can be seen as cheating, overall, the effects on others might be positive, because if we become healthier and more productive members of society, society as a whole might benefit.
Each one of us has a direct or indirect impact on many other human beings, either because we directly interact with them or our lives indirectly touch through a myriad of ways.
So, let’s turn the argument around. Past-me was somewhat depressed, irritable, and living massively below his potential. One could argue that it is pretty unethical not to intervene because if I have the means to do so, inaction is also action (which would be my answer to the famous “Trolley Problem”). Moral bioenhancement.
If I had decided to do nothing, it would not just be me that is hurt but also my loved ones. Indirectly, also society would be hurt in countless and often quite obscure ways. I would not be contributing what I otherwise could, instead, I might have become an involuntary parasite living off society’s resources.
On the other hand, If my energy, mood, and health are better, I can be a better contributor to others. Humanity is rather about cooperation than competition.
5. Should you replace your hormones?
Is hormone replacement healthy?
Many of us have the “there-is-no-free-lunch”-mindset, assuming that taking any drug (or hormone) is “bad” and that we will surely pay the price for it down the line. However, this is not how the world works.
Multiple hormone replacement has been used extensively by anti-aging specialists for decades. They found that, if done correctly, replacing deficient hormones with the use of small and physiological doses is both healthier and safer than not doing so.
We have data from thousands of people whose pituitary glands were destroyed or removed in their teens or young adulthood (e.g. due to cancer, injury, radiation damage, etc.).
Within only a few days, their endogenous hormone production drops to zero, forcing them to replace all of their major hypothalamic hormones for life (growth hormone, thyroid, sex hormones, adrenal hormones). From that point on, all of their hormones are completely introduced from the outside.
Some early studies have shown mortality for these people to be elevated, mainly due to cardiovascular diseases. However, later it was found that this was mostly due to two things. Firstly, glucocorticoids were often given in excessive doses due to concerns that patients would suffer from a life-threatening adrenal crisis. Secondly, growth hormone was often not replaced at all.
Given hormones are replaced well, the difference in mortality withers away. Furthermore, these people live longer and healthier lives than their peers, whose hormones decline naturally across the board with aging.
Furthermore, optimizing hormones gives us higher energy, mood, and motivation, which makes living a healthy lifestyle much easier. Given that around 80% of deaths in Western countries are due to cardiovascular diseases, cancer, and neurodegeneration — all of which are lifestyle diseases- optimizing hormones has indirect beneficial effects as well.
While there might be some risks and side effects associated with hormone replacement, there are also risks and side effects if we choose to not replace a deficient hormone. Most people forget about this.
The power of analogy
Let’s say you are a chronic insomniac. You have tried out countless different remedies, lifehacks, and “natural” supplements but other than the transient short-term improvement, nothing really seems to provide lasting relief.
The lack of sleep makes you fatigued during the day. You cannot focus. Your willpower is low and thus your tendency to procrastinate, make bad food choices, and skip any exercise is high. Your metacognition is awful and your attention span non-existent. Your work performance sucks. You are more withdrawn but also markedly more irritable in social interaction. Also, your life enjoyment is much lower compared to what it could be.
Furthermore, the increased sympathetic drive and hypercortisolism wreaks havoc on our metabolic health, which along with your suboptimal diet and exercise regime, led to you bordering on metabolic syndrome. You have read how “bad” all this is and that it is supposed to drastically increase your risk for neurodegeneration, cardiovascular disease, and cancer, the three of which are responsible for most deaths in Western civilization.
You thought about taking sleeping pills. However, after doing some research online, you decided against it. They just seem to have many nasty side effects, cause tolerance build-up, interfere with memory consolidation, and people cannot get off them. They are just simply “bad” for you.
True, all of these are legitimate concerns, and relying on sleeping pills is “bad”. However, bad compared to what? The question should not be, whether something is “good” or “bad”, but what is worse? For your health, your wellbeing, your life, your impact on others? Sleeping badly for years on end (including all the ripple effects this entails) or taking sleeping pills?
The same holds true for hormone replacement. Our hormonal profile is one of the most important things in our life. If one of our hormones is low, it will hold us back. Despite being aware of this, many people are scared and worry about the risks, side effects, nuisances, costs, etc. However, the problem is that most of us look only at this side of the equation. What are the risks and drawbacks of not replacing a deficient or suboptimal hormone? What are the opportunity costs of inaction? In the end, it is a complex calculation of tradeoffs:
- Risks, side effects, costs, nuisance of therapy
- Long-term effects on your health: Firstly, direct effects as every hormone directly interacts with every cell, tissue, or organ. Secondly, the indirect effects mediated by improved energy, mood, and health, which affect your lifestyle choices, which then, in turn, affect your health as well.
- Long-term effects on your mental health: Needless to say, your mind is all you have.
- Moment-to-moment wellbeing and quality of life: How we feel right now. Great energy and mood simply feel good.
- How the decision to (not) intervene will affect your “objective” life situation down the road: Regardless of current years being lost, there is also the risk of massive damage to be done to your future life situation (e.g. social life, career, partner, wealth, bad lifestyle habits leading to health issues, etc.). Also, considering that many of these effects are permanent (e.g. break-up, layoff).
- Healthspan: How long we can live more or less free from pain, suffering, and disease.
- Lifespan: For example, both thyroid and growth hormone treatment might reduce the maximum theoretically possible lifespan. However, via their countless ripple effects both on your biochemical health (e.g. weight, atherosclerosis, brain health, immune system, metabolic health) but also via their effects on your vitality and wellbeing (which affect lifestyle choices) they might increase lifespan overall (…and no question about healthspan…or quality of life).
- The effects you have (or do not have) on others. This last point is often neglected. It is not just about you. The way you act, what you do or do not do, what or what not you contribute to others, the resources you consume -they will all have an impact on the life of many others as well, either directly or indirectly.
So, in our risk-benefit analysis, all of these factors need to be addressed, for which we need to look at both sides of the equation. Even if there are risks and side effects with therapy, they need to be weighed against the risks and side effects of doing nothing, which comes with risks and side effects as well. The last point is often dismissed.
6. How I optimize my hormones
Disclaimer: None of what is presented in this article is medical advice. Everything is for informational and entertainment purposes only. If you have any queries related to health, diagnosis, or treatment, always consult with a medical professional.
My goal with hormone optimization is to maximize the intersection of three things that usually require tradeoffs:
- Short-and long-term health
- Short- and long-term performance/productivity
- Short- and long-term wellbeing/life-enjoyment
So, here is what I found works well for me. Engineering this protocol laid out below, took years of finetuning and tinkering. A huge amount of research, experimentation, blood tests, monitoring, suffering, etc. went into the following few lines taking about 30 seconds to read. For rationale and explanation about why I replace my hormones the way I do, read the respective sections for the individual hormonal axes.
- Sex hormones: Testosterone cypionate (50mg subcutaneously 2x/week), HCG (125iu subQ 2x/week), FSH (50iu subQ 2x/week) (For more infor on how to replace male sex hormones, click here.)
- Adrenals: 20mg hydrocortisone-equivalent per day (split into five daily doses), 0.1mg fludrocortisone, 25mg DHEA (Click here for more info.)
- Thyroid: 1.25 grains NDT (I used to experiment with different ratios of T4/T3 but I found NDT to be best and also most convenient) (Click here for more info.)
- GH/IGF1: 0.5 IU GH in the morning (Click here for more info.)
I also take 0.25mg melatonin before bedtime and 20.000iu vitamin D per week. These are hormones as well.
Other stuff I do to improve my vitality: low carb diet (For more: A Diet That Works For Everyone), exercise every day (either zone 2 cardio, HIIT, gym), sleep around 6.5h, weekly rapamycin, a fasting-mimicking diet 4x/year, a bunch of supplements (For more: Supplements everyone should take.), meditate daily, no caffeine, and various pharmaceutical drugs (e.g. low dose rosuvastatin, allopurinol, acarbose) for which I believe -based on an educated guess- the risk of taking them is lower compared to the risk of not taking them. So, which is more potent? My hormones or all the other stuff I do? Well, I have been high and low in every major hormone in many different combinations. When it comes to determining our energy, our mood, our overall health, I would go as far as to say hormones account for about two-thirds.
Some might now think “this guy is crazy”. Anyhow, most cannot imagine the dreadful state I was in, with energy levels that left me feeling like life was not worth living anymore. Once you have been in such a state for long enough and have been forced to watch how many aspects of your outer and inner life degenerate over time, you are desperate to try anything. In fact, it’s only after we’ve lost everything that we’re free to do anything. To read more about my story: How Hormones Destroyed And Saved My Life -From The Brink Of Suicide To Bliss.
Furthermore, from the outside, all this does seem to be a lot of effort. However, it truly is not. The hard part is figuring out what to take and how much. But once a stable protocol -finetuned to one’s needs and liking- is established, administering all these hormones takes less than a minute per day. A tiny price to pay for the reward I get. Replacing my hormones is an inconvenience and nuisance. But that is all. It is just an inconvenience and nuisance.
Within a year or so, this protocol completely remodeled my body, mind, health, and life. For an overview of the effects that each of these hormones had on me individually, read here: Which Hormone Did What?
In general, the target range I aim for is the upper tertile of the youthful reference range. However, I am aware that, when it comes to endocrinology, physical signs and symptoms matter just as much as numbers on a paper. More on that later.
I believe, this hormone replacement protocol marries performance with wellbeing and longevity and strikes a reasonable tradeoff between these, bestowing me with the kind of vitality some of us naturally experience after sexual maturity, but which I was deprived of. Furthermore, with the choices and dosages presented above, my hormone levels are well in balance with each other.
Optimized both for longevity and performance, I can and do keep the different hormones where I feel and function best. However, I am aware that all this is rather uncharted territory. I am well aware of the risks. But to me, the cost-benefit analysis makes it a straightforward decision. What did I have to lose?
Even if my lifespan were reduced (which I doubt), I would rather opt for a below-average-length life of feeling great and enjoying the time I am given instead of living for much longer but feeling awful all the time. If I had to, I would even sign a contract to live just 10 more years in the state I am in now and then die, rather than living for over one hundred more years in the vegetating state I was in previously.
The only life I have got in this universe is too precious to live with low energy, mood, and health. Life is about filling time and not merely passing it. I am here to grow personally, to contribute, and to enjoy. However, if my hormones are deficient, none of these things is on the cards because my capacity for these depends on my biology, which is greatly influenced by my hormonal profile. Therefore, improving my biology via hormones enables me to better tackle problems and goals in life with much more energy, mood, motivation, enthusiasm, clarity, cognition, persistence, resilience, health. Besides, I can now enjoy the whole journey, which is the main point.
Whether I can keep this up for decades, I do not know. But I cannot see a reason why I should not be able to. Also, I simply do not know how long the world will still exist. Climate change, (an engineered) virus, supervolcano, singularity. While the chances that we become something far greater in the 21st century are high, the chances we screw up are high as well. In the case the world falls apart in the next 20 years or so, I have certainly made a good deal.
Changes I have noticed over the years
Within a year or so, this protocol completely remodeled my body, mind, health, and life. For an overview of the specific effects that each of the individual hormones had on, read here.
The most “life-changing” benefit I have got from hormone optimization is certainly the vast improvement in energy levels. In fact, thyroid and adrenal treatment brought me back to life.
Before hormone replacement, it took me forever to wake up. I was lethargic most of the day. Everything seemed hard to do and required a lot of willpower. When it came to cognitive tasks -or even movies or books, maintaining focus was impossible because whenever I sat down, I got very sleepy very soon.
Conversations were drudgery. Socializing was dreadful. Med school was a chore. I had to rely on stimulants to function and without caffeine, modafinil, ephedrine, cold showers I would have been moping around somewhere all day.
With low hormones, I wanted to lead a quiet and secluded life and only engage in low-effort activities that did not require a lot of physical movement. Soon after starting treatment, I regained the energy and motivation I remember from my adolescence. From that point on, I again wanted to go out and do something physical, I again wanted (some) stress and challenges, and I also again wanted to go out and meet people, I wanted to enjoy life.
Whereas before I was likely below the 5th percentile in terms of energy levels, now I feel I am close to the top. Nowadays, I could be productive during most of my waking hours if I wanted to. This does give me a significant advantage in life.
From personal experience, I would guess that about 70% of my energy levels come directly from hormones. 30% is everything else (which in people not replacing their hormones often mediates its impact on energy levels at least in part via the endocrine system).
From all this I learned two things about hormones and energy levels:
- A deficiency in any of the major hormones can cause chronic fatigue -even if all other hormones are at optimal levels.
- Each hormone deficiency is associated with a distinct kind of fatigue. To learn more about what the fatigues associated with different hormones “feel” like, click here.
During my low-hormone years, I had little motivation to do things. Upon starting hormone treatment, my drive and motivation to do things vastly improved. Furthermore, I also seemed to get much more enjoyment out of things, which also helps with motivation. Now, most of the time my general motivation to do things is high, with little to no procrastination. Among other things, this is likely at least in part due to the way how hormones interact with the dopamine system (esp. testosterone and cortisol).
For me, motivation, willpower, and self-discipline all correlate strongly with my energy levels at any moment in time. Procrastination almost exclusively happens when my energy levels are low (for example, when I have not slept well or ate an insulinogenic lunch). Then, everything requires a lot of effort and I have to “push” myself to do something. I then often start to “half-ass” around (e.g. browsing the internet). My productivity is about half of what it could be, enjoyment much less. However, if I then improve my energy levels -whether this means sleep, exercise, cold shower, hormones, stimulants, coffee, etc. does not matter- this lack of willpower, motivation, and discipline, goes away instantly. Doing the “hard” things now suddenly becomes much easier.
It is always fascinating to read about people trying modafinil for the first time. Simply by elevating energy levels, they are now instantly much more productive. They automatically stop procrastinating and start doing. No further willpower or “pushing” required. Purely as a byproduct and second-order consequence of having higher energy levels will they start tackling life with much more vigor and proaction.
I bet many “chronic procrastinators” are the way they are because their energy levels are quite low most of the time. They might blame themselves, telling themselves they are simply “not strong enough”. True, but a large part of that “strength” is simply biological. While one might be able to pull oneself together on an occasional day of low energy, how about if this state continued for multiple years? Likely one would not even have been able to build a habit of willpower and self-discipline in the first place. Of course, willpower has a lot to do with psychological factors as well, such as the capacity to delay gratification, self-discipline, how much one is interested in that thing one wants to do, etc., but all else being equal, I would guess that energy levels per se are at least 50% of the equation.
It is important to keep in mind that mood, motivation, and energy levels are all intricately linked and we can’t look at them separately. During my adolescence, my mood was always great and I was quite a buoyant person. Others enjoyed being around me.
As my hormones fell, life somehow turned grey and my mood was “meh” at best and much more fluctuating. Hormone optimization felt as if someone had turned on color vision again. My mood has vastly improved, which is now mostly good and has few fluctuations -other than normal highs and lows which are not biochemically mediated.
In case any “bad mood days” happen, I found that, If I want to change my thoughts, I should focus first on my body, before doing anything else. Because, at least for me, my biochemistry to some extent determines my thoughts and outlooks. For example, if I am lethargic or low in energy -which is mostly biochemical- it is just a matter of time until my biochemical state is reflected in my mental state (i.e. thoughts, outlooks, thinking patterns). Then, a good night’s sleep, good food, or going for a run ( → ”You are only one workout away from a good mood.”) is often the only therapy I need and many “existential questions” take care of themselves. Then, my mental state does not just affect my “inner” life but also affects how I behave in the real world, which ultimately ripples into my “outer” life. One time in the past, I quit T3-administration cold-turkey. This caused all my thoughts and outlooks to follow my biochemistry and led to me having a panic attack and an “almost suicide”. I learned some powerful lessons from this (un)fortunate experience: Why depression is a chemical imbalance but not the way you think. Lessons from MDMA, bipolar disorder, self-experiments.
Before hormone treatment, I felt like I gradually became dumber and dumber. My mind was just not “sharp”. My ability to concentrate was poor, my thinking fuzzy, and I had to read every sentence multiple times to understand and to remember what I have read. The combination of good hormones, good sleep, a low carb diet, completely took care of this. Furthermore, this combination is also healthier and more sustainable than any stimulants or nootropics I have tried in order to desperately make up for my lack of energy, motivation, and cognition. Now, my cognition is almost always sharp and most of the time I am alert (which is also quite a pleasurable state to be in). Furthermore, hormone treatment made me much more quick-minded and gave me back the wittiness I remember from my adolescence.
How could someone enjoy nature, a beautiful view, a good conversation, a movie, girls, etc., with a racing mind, low energy levels, little emotions, heavy limbs, and a “meh” mood? Up until my early twenties, I was able to enjoy life fully. However, as my hormone levels declined between 20 and 23, I was plagued by anhedonia and I could not derive joy from anything anymore (e.g. books, movies, friends, exercise, studying). After just a year of hormone replacement, every form of anhedonia is gone. Now I am able to enjoy myself and life, simply because my brain can generate the appropriate emotions again. The mind is what the brain does. And hormones have a major say in what the brain does. We all know those people who seem to be able to live life to the fullest (always full of energy, experiencing intense emotions, cognition, health, drive, and motivation). Well, in order to live a life like that a great hormonal profile is certainly a prerequisite.
Whenever we tinker with neurobiochemistry, over time, our personality changes. The direct effects of hormones, as well as their indirect effects on certain neurotransmitter systems (esp. dopamine, serotonin, noradrenaline), alters short-term, moment-to-moment brain function (e.g. mood, wellbeing, cognition). This is readily apparent when we drink coffee, take stimulants or recreational drugs. However, over long periods of time, these changes induce structural and functional neuroplastic adaptations. Personality is mostly dependent on structural (synapses) and functional (strength of these synapses) brain wiring. Therefore, whenever neurobiochemistry is influenced in a sustained way for longer periods of time (e.g. hormones, antidepressants, etc.) this will alter our thinking-patterns (e.g. coping mechanisms, outlooks on life) and also have structural consequences, both of which will eventually manifest in behavioral changes (personality).
Here I describe some of the personality changes I have noticed. Some of these I have not noticed myself but were pointed out to me by others.
Energy levels: Energy levels by themselves have quite a lot to do with who we are. Therefore, as my overall energy levels changed, so did my personality.
Greater self-confidence: I feel that this one was mainly caused by testosterone. Over the years, I became much more confident and now I truly do not care what anyone thinks of me (+/-). For example, before TRT I was self-conscious about my height (5’8) but now I could not care less.
Less obsessive: During my low-hormone years my mind was always racing. I was living in my head and I just couldn’t “turn it off”. I was rigidly self-disciplined bordering on obsessivity. I was very future-focused and evaluated everything I did based on how “productive” something was and how much “utility” it had for me. While rigid self-discipline is good for productivity and advancing my objective life situation (e.g. career, knowledge, fitness, money, etc.), it is not a conducive way to interact with others. Furthermore, it is simply not an enjoyable way to live life because I could not just enjoy the moment or “be present”. This has changed. Now, I am much more “chill” and can just be here and now. This is worth a lot to me.
My shift from obsessivity, rigidity and productivity to more complacency and life enjoyment does have some downsides as well. For example, I am no longer in this chronic state of mental unease, so I somewhat stopped asking the “why”-questions many would not bother asking in the first place. Before, I really wanted to understand things (e.g. physics, medicine and any other science). Furthermore, my inability to “turn it off” was the foundation of many of my personal accomplishments. For example, I would not have delved into endocrinology as much and therefore I would not have written this guide.
Less “academic”: With all hormones being low, I was void of intense emotions, because my brain simply could not generate them ( →The mind is what the brain does). I was more of a “robot”, quite technocratic and data-driven in my approach to life. Furthermore, during my low-hormone years, I became quite detached from reality and I could not stop thinking and researching about stuff that did not matter at all to my life (e.g. plant reproduction, quantum physics, abiogenesis). After replacing my hormones, for some reason, I became much more concerned about my own personal life (e.g. relationships) and much less about more “abstract” stuff. This has both upsides and downsides.
More emotional: Before, my emotions were dull and grey. Nothing could get to me. In fact, some friends called me an “imperturbable rock”. Whenever I interacted with the people I loved the most in the whole universe (my family), my emotions were rather cognitive (“I know I love them”). Now though, I felt love for my loved ones again. That warm fuzzy feeling I thought I had irreversibly lost. Now though, I am more emotional in general. A minor downside of this is that the intensity of my negative emotions has increased as well. For example, when my girlfriend recently broke up with me, I experienced emotional intensities that were stronger than everything I have experienced in my adolescence. Besides, increased emotionality can have downsides in terms of productivity.
Empathy: Before hormone replacement, I was quite judgmental towards others. Furthermore, most of the time I was always quite “parasitically” looking for my own personal advantage. Hormone replacement made me much more empathetic, much less of an asshole. Now I truly care about others and genuinely want the best for them. Among other things, this certainly has a lot to do with how hormones regulate serotonergic tone as well as oxytocin signaling.
Social (an)hedonia: During my low-hormone years, social interaction gave me no pleasure whatsoever. I just wanted to be by myself and did not feel the need to be social. Whenever I interacted with people, I just wanted to get away as fast as possible to do “my” things. Hormones have changed this. I suddenly did not want to be by myself anymore all the time. I started to deeply enjoy meaningful social interaction and emotional closeness with others became very important to me. As my hormones improved, my social anhedonia was obliterated. If I had to rank the importance of the hormones for curing my social anhedonia, I would say: cortisol > estradiol (improves with TRT) > thyroid hormones> testosterone.
Sociality: Before, social interaction gave me no pleasure whatsoever. Furthermore, being social was drudgery and pretense. Drudgery to muster the necessary energy and pretense to fake my “old” adolescent personality that I had lost. This led to me becoming more secluded and withdrawn. I just needed and wanted to be by myself. This has changed. Being social is not drudgery and pretense anymore. Now I wanted to go out and meet people because I had genuine fun again.
Note: Deliberate intervention into one’s neurobiochemistry is certainly not necessary for personality changes to occur because this happens naturally as a byproduct of getting older. Perhaps the strongest reason so many of us undergo subtle changes in personality over the years, is simply due to all of our hormones gradually declining across the board (e.g. males get less aggressive, more calm, etc.). So, even if I did not intervene, some aspects of my personality would have changed “naturally” anyway, just not as strongly and fast -and into the other direction.
Of course, these changes were not just due to hormone replacement alone. However, an adequate hormonal profile was undoubtedly a prerequisite and also the primary catalyst. As you might have noticed, each of these changes also carries some downsides (e.g. less objective, less productive, increased negative emotions, etc.). However, in my opinion, the minor downsides are a small price to pay, but whether the second-and-third order consequences for me or others will be good, remains to be seen.
Regarding these changes in personality, the biggest differences were caused by estradiol and cortisol. If any of these is truly low, then obsessivity, rigidity, emotional coldness, social anhedonia are almost certainly a given. For more about which hormones were responsible for which changes (as far as I can segregate their effects), read here.
What I realized is that vitality (energy levels, mood, health) is the most important factor for self-improvement.
An example to illustrate what I mean. I am not always “nice” and I usually tend to say whatever I think straight to someone’s face. After having had multiple bad experiences with this “method”, I decided that I wanted to be somewhat nicer to people because being too straightforward/rude is not always the optimal thing to do (e.g. cultivating friendships, trying to persuade others, working towards a goal that involves collaboration, etc.). But if my energy levels are low and/or my mood bad I am not able to apply any advice, tactics, strategies, etc. because I am simply not mindful enough but instead on on autopilot all day long.
I believe that mindfulness is one of the most important skills to learn, not just for “self-improvement” but to get the most out of life in general. Well, trying to be “present” and “mindful” when I am lethargic, sleepy, irritable, brain-foggy, etc. is futile.
For me, the most effective way I have found to apply advice or strategies related to self-improvement is twofold.
- Firstly, I need to have high energy levels.
- Secondly, I need mindfulness (for which high energy levels are also required but not sufficient).
If both of these are present (no pun intended), my “window of agency” increases, which allows me to act instead of to re-act. Therefore, taking adequate care of my vitality (esp. via hormones) is a prerequisite for being at least somewhat mindful, which is a prerequisite for being able to effectively apply any self-improvement stuff. On the other hand, if just one of these is lacking, I cannot help but be mostly on autopilot. I can read ten books about how to be nicer and more compassionate, but I am still the same old, mindless asshole when somebody is rude to me, having acted in my habitual autopilot-mode long before I can pull out my nice and neat little list of strategies about how to win friends and influence people.
Side note: Unrelated to mindfulness, if my energy levels and mood are good/better, I am automatically much nicer to people, without even having to try. This automatic change in my behavior is quite unlike any intentional “self-improvement”-changes I try to make. No need for painstaking unlearning, relearning and habit formation. For more on this, read the section “Becoming different: Changing our autopilot”, here.
Furthermore, having high energy levels and some mindfulness is not just incredibly effective for self-improvement, it is also an awesome way to live. In fact, with these two components, I am getting more enjoyment out of every single moment. And my life is just a string of individual moments right next to each other. Hence, I get more out of life.
Effects on others
Now I am less aggressive, less judgemental, less of an asshole. My emotionality is higher, my capacity for empathy greater. Before I was just parasitizing and consuming, now I have the necessary energy, mood, and desire to give back.
If I become a healthier, happier more functional, and more productive individual, not only me but also others are better off for it. Not only is it beneficial to the people I directly interact with (e.g. family, friends, contacts) but also to society as a whole (e.g. whatever I contribute, whatever I do that touches the lives of others).
If I had decided to do nothing, it would not just be me that is hurt but also my loved ones. Indirectly, also society would be hurt in countless and often quite obscure ways. I would not be contributing what I otherwise could, instead, I might have become an involuntary parasite living off society’s resources. I would argue that if I am low energy and depressed all the time, it would be pretty unethical not to intervene because if I have the means to do so, inaction is also action.
I found that the best way to change my life is to change what my life is made up of: My habits. Changes that seem small and unimportant at first will compound into remarkable results if I am willing to stick with them for years. Big achievements are about the tiny, non-sexy things, done day in and day out, for very long periods of time. But guess what? With low energy and mood, changing my habits (let alone sticking to them) is impossible. For me, bad habits are mostly a function of my energy levels and mood at any given point in time. If I feel lethargic and unmotivated all the time, eating well, sleeping well, exercising well is simply not on the cards.
Before hormone replacement, I required around 9h of sleep but still did not wake up refreshed. Optimizing hormones has vastly improved my sleep, which by itself improved everything else. Now I usually get around 2 hours of slow-wave-sleep and around 1h or REM sleep (Oura data) and I wake up refreshed without an alarm after around 6.5 hours. Hormone treatment decreased my sleep needs by about 1–2 hours. This is worth a lot to me because I love this additional time every day. Compound interest if I use it well.
Fatigue: An interesting aspect I have noticed is this: because I replace all my hormones, a lack of sleep does not interfere with my energy levels much. For example, when I for whatever reason, only sleep for 3–4h, my energy levels are still largely the same. However, I feel somewhat “drunk”: I can’t think very well and straight, my metacognition is awful, and all my executive functions are diminished.
Maintaining low body fat year-round without any effort. To see how I look after four years of hormone replacement therapy, Click Here.
The changes are describe in “How To Replace Male Sex Hormones- An Ultimate Guide.”
Some select health markers (average numbers collected over years):
- Respiratory rate at rest: around 15/min
- Immunity: Since starting hormone replacement I have never been sick in 5 years (1–2x runny nose per year at most).
- BMD: My bone mineral density increased from a Z-score of -2.2 (almost osteoporosis) to -0.7 within 1 year of treatment.
- Spermiogram: sperm quality improved vastly
- Blood count: Pancytopenia → normal blood count
- Body fat: around 10% (has not changed much)
- Blood pressure: 105/60 → 125/60
- Resting heart rate: around 50 (has not changed much)
- Average HR: 55/min
- Core body temperature: 36.5 am → 37.0 afternoon (before, morning, and afternoon body temperature were about 0.4 C lower)
- Heart rate variability: around 70ms
- Ketones: average around 1 mmol/l
- Blood glucose: between 80–90mg/dl with little SD
- HBA1C: 4.8% (has not changed much)
- Uric acid: around 4.5 mg/dl
- Lipids: Fasting triglycerides around 30 mg/dl; HDL always above 120 and LDL below 50 (I did not confuse these two). However, HDL is likely a worthless proxy. LDL is not really meaningful either, but it is all about particle number. My ApoB is around 50 mg/dl.
- Liver enzymes: GOT/GTP between 30–40 U/L. Could be better.
- CRP: only measurable once in the last 3 years
Note: Are hormones more important than lifestyle? Can an artificially optimized hormonal profile protect us against a bad lifestyle? Is an optimized hormonal profile combined with a healthy lifestyle additive, synergistic or are there diminishing returns? My dream experiment would be to clone someone a few times. Then compare the effects on health & longevity in terms of:
a) A great lifestyle vs.
b) Optimized hormones + a bad lifestyle vs.
c) Optimized hormones + a great lifesyle
7. Improving hormones naturally
When I tell others about what I do, one of the most common questions I get is: “Well, have you found the cause?” Many people assume that if I were to just make the appropriate lifestyle changes, my hormones would be back to normal. This is also one of the most common misconceptions about hormones: Namyle, that they will improve if we just live a healthy lifestyle.
Sometimes prolonged sleep deprivation, a bad diet, and extreme stress can indeed take a toll on our hormonal health. However, often our lifestyle has not much to do with one or more of our hormones being low. So what are the causes then?
Well, when it comes to hormone deficiencies, there can be hundreds of different causes…from genetics, in-utero development, early brain maturation, head trauma, prescription drugs, sleep deprivation, terrible diet, etc. In many cases, the cause (or combination of causes) cannot be determined.
Furthermore, often, there is no specific “cause”. Low levels of one or more hormones can simply be someone's natural state. By definition, 5% of people fall naturally below the 5th percentile. When it comes to hormones, these people simply have not been dealt a good hand. What possible improvement is there for someone that is naturally at the very left tail end of the Bell curve distribution?
The causes of hormone deficiencies
As explained above, hormone deficiencies are caused by one of four things:
- Category 1: Acquired hormone deficiencies with clear-cut causes (e.g. starvation diet, sleep deprivation, excessive stress, prescription drugs, nutrient deficiencies, birth control pills, phytoestrogen consumption or other endocrine-disrupting chemicals). Often but not always, once the cause is removed, the hormone deficiency takes care of itself.
- Category 2: Acquired hormone deficiencies but with more “vague” causes (e.g. traumatic brain injury, impairment during intrauterine development, aging, abuse of anabolic steroids, immune infiltration of hypothalamic regions, mutations in enzymes responsible for hormone synthesis, allergies and inflammatory conditions). Following lifestyle interventions, hormone deficiencies might improve somewhat (e.g. 10–20%).
- Category 3: Naturally low hormone levels despite both development, health, and external conditions being optimal (esp. genetics and early brain development). For this group, nothing can be done “naturally” to improve hormone levels.
- Category 4: While all of the above are caused by hypothalamic issues (i.e. a lack of brain signal), hormone deficiencies can also be caused by dysfunction of peripheral glands. Examples include testicular varicocele, testicular torsion, autoimmune attack (e.g. Hashimoto, Grave disease, autoimmune Addison disease), nodules/cysts/tumors, injury, deficiencies (iron, zinc, selenium, iodine). Other than the autoimmune diseases, in most cases, the cause is quite easily determined and also rectified. The characteristic of this category is elevated levels of stimulating hormones in the blood (e.g. LH, FSH, ACTH, TSH). Furthermore, in this category, it is usually just a single hormone that is deficient, whereas for all the other categories, in many (but not all) cases, multiple hormones are borderline low.
I have had an MRI performed of my pituitary gland. A 1cm cyst was found in my pineal gland (which is adjacent to the hypothalamus and pituitary gland). It might be the case, that this cyst had developed sometime around late puberty and started to interfere with the hypothalamic or pituitary output of releasing hormones. Considering that multiple hormone deficiencies seemed to occur quite abruptly after I was 18, or 19 years old, this seems like a plausible explanation. This would put me in category 2. Alternatively, it could also be that this cyst had been present since birth and is purely coincidental, which would mean that I rather fall into category 3.
Even though my lifestyle was certainly not “impeccable” between the age of 18–22 (e.g. partying, little sleep, etc.), the fact that leading a great lifestyle for over six months did not cause any improvement in my hormones, makes it unlikely that I fall into category 1. In fact, I tried out countless things to improve my hormones “naturally”. However, nothing seemed to work. Therefore, I had to come to terms with the fact that either I do have a cyst that interferes with adequate production of my hormones (category 2), or that low hormones are likely my natural state (category 3) -or a combination of both. Either way and whatever the case, after hundreds of hours of agonizing back and forth, I decided that I do not want to accept this.
However, just because “natural” methods did not work for me, they might work for other people, whose hormones would naturally be much higher but are just temporarily suppressed by suboptimal conditions or other clear-cut causes. In these cases, there might be one or more specific causes that can be determined and rectified (category 1). If this is the case, hormone levels might improve naturally again -sometimes drastically.
Here are some things that you can do to improve hormones naturally. Most of these apply to people who fall into category 1. The following list is not like the countless bullshit-lists circulating everywhere around the Internet intended for nudging people towards buying someone’s panacean product. Every single point on this list works. However, while many points on this list are incredibly simple, they are much easier said than done.
- Calories: Make sure your caloric intake and insulin levels are not too low — perhaps the most important point on this list. I will talk more about it in the subsection below.
- Sleep: Make sure you get enough sleep. Sleep deprivation disrupts hypothalamic signaling to peripheral glands.
- Stress: Make sure your general levels of stress are not too extreme for too long. Although as vertebrates who evolved to live in the wild and therefore we should naturally be quite resilient and able to tolerate a fair amount of stress. However, stress was usually short-lived and thus we should try to eliminate any chronic stressor as much as possible (e.g. caloric restriction, infection, extremely stressful life, intense schedules, excessive exercise, regular fasting). In the most extreme case, prolonged chronic stress can lead to burnout syndrome. For more info on burnout syndrome, what it is, what causes it, and how to reverse it, see here.
- Deficiencies: Make sure you have no vitamin or mineral deficiency. (e.g. vitamin B12, vitamin D, iron, zinc, magnesium). Furthermore, forget about all the lists of “super-foods” and “super-supplements” to improve hormones “naturally.” Most of them are a scam. Others, at most, will give a gain in the single-digit % range. (But there is a list of supplements I do recommend. See here.)
- Drugs: Make sure you are not regularly taking any molecules that interfere with hormone signaling or production. (e.g. opioids, weed, alcohol, some prescription drugs).
- Melatonin: Make sure you are not taking too much melatonin, which in high dosages inhibits the production of thyroid hormones, sex hormones, and cortisol. Although interindividual sensitivity varies. For a more detailed discussion on melatonin and how to best supplement with it, see the respective entry here.
- Xenoestrogens: Avoid excessive amounts of xenoestrogens (esp. soy products). They mimic estrogen, which leads to negative feedback on the gonadotropic axis.
- Supplements: There are two supplements that might help. These are the herbs Ashwagandha and Rhodiola. Both of them seem to have serotonergic properties and it turns out that the 5HT2A-receptor stimulates hormone production throughout the hypothalamus. Furthermore, any serotonergic agent decreases (perceived) stress and may therefore facilitate recovery from stress-induced hormonal imbalance. In general, though, I recommend avoiding most supplements. read The Dark Side Of Supplements: Why You Should Choose Prescription Drugs Instead.
- Pregnenolone: Sometimes, supplementing with pregnenolone, which is a precursor hormone to all steroid hormones, can in select cases lead to an increase in the levels of the final target steroid hormones (cortisol, testosterone, estradiol, progesterone, aldosterone). For a more detailed discussion on pregnenolone and how to best supplement with it, see “How To Replace Non-Major Hormones: An Ultimate Guide”.
- Head trauma: Check whether you had a major (or minor) head trauma (e.g. football, military, boxing, concussion, etc.). Head trauma is a common but neglected cause of hormonal problems. During a major (or minor) blow to the head, the axons making up the pituitary stalk often break, which sometimes causes permanent hormonal deficiencies -or a slight reduction in one or more hormones, which often remains subclinical for the rest of the individual’s life without anyone ever noticing. If this is the case, there is not much “natural” stuff someone can do other than going down the replacement route.
While some people will be able to improve their hormone levels naturally via a combination of these methods and patience, many others will not -or at least not to a satisfactory degree. Many can do everything by the book and lead an impeccable “improve-your-hormones-naturally-lifestyle”, often sacrificing lots of time, effort, happiness, and life enjoyment in the process.
However, often, hormone levels do not budge at all and sometimes the improvement is a mere 10–20%, which in real life does not move the needle much. Whether that is worth it to you or not is up to you.
When it comes to natural levels of hormones, all of us have a certain set point for each of the major hormones. Some people just have a great hormonal profile naturally, sometimes even despite an unhealthy lifestyle and doing everything almost diametrically opposed to the list above (e.g. bad diet, little sleep, lots of partying, no exercise). However, some people’s setpoints are naturally low, even when all external conditions are optimal.
For example, let’s say your testosterone or thyroid hormones are rather at the low end. You try to eliminate potential causes (e.g. stress, sleep, diet, chemicals, etc.). If your set point is low naturally (e.g. genetics, early life environment), hormone levels will not budge, regardless of what you do. No supplement, diet, or lifestyle intervention will help. Blaming your parents will not help either. In fact, these differences in endocrine set points account for many of our natural differences in temperament, energy, and personality.
If for some reason your hormones are not adequate (and if lifestyle changes are not able to correct for that because perhaps our setpoint for one or more hormones is low/suboptimal), you will likely always be living, functioning, and experiencing life massively below your potential. You can focus on nutrition, exercise, sleep, supplements, and the most perfect lifestyle but a deficient or suboptimal hormone will always be your limiting factor.
Note: Let’s say someone screwed up his hormonal balance by years of inadequate sleep, crappy diet, partying, etc. Will everyone be able to recover his baseline by adopting great lifestyle choices? Some people yes, some no.
Many shy away from hormone optimization because they worry about the side effects, nuisance, risks, costs, etc., but the problem is this: Most of us look only at this side of the equation. What are the risks and side effects of not replacing deficient hormones?
Note: In my case, even though hormone issues may not be my fault, this is my life -the only one I have- and therefore, it is on me to take responsibility. So, I decided to take matters into my own hand. However, I have to admit that it surely does help to arrive at a point where you do not have much to lose anymore. (For more: How Hormones Destroyed and Saved My Life — From the Brink Of Suicide to Bliss.) Whether I would have even started replacing my hormones if I had been in this greyish “in-between” area, I do not know. Likely not. At least not yet. However, now after around 5 years of therapy, I can say that, for me, the positive effects of intervention seem to vastly outweigh any downsides and I believe, as long as I do it correctly, there is likely a large net benefit for me (e.g. health, quality of life, life enjoyment, productivity). All of this will (hopefully) also improve my contribution to others.
Insufficient caloric intake: A common cause of hormone deficiencies
To ensure adequate functionality and health of our organism, a sufficient caloric intake is required. This point is so important that it deserves its own subsection. Given you have no major nutrient deficiencies (which is usually the case), the most important factor in your diet is simply the total number of calories we eat. Unfortunately, this point is widely and heavily neglected and all the focus is mostly on nutrient intake (e.g. vitamins, minerals, “superfoods”). However, we are heterotrophic creatures, and ensuring energy intake is one of the most important things heterotrophic creatures (e.g. animals) do.
Unfortunately, obsession with “fitness” has become pervasive, in fact, ubiquitous. Both males and females try hard to achieve or maintain low levels of body fat, in the process often restricting calories for long periods of time. It sure does not help that people use online calculators to determine their TDEEs. Most of these algorithms severely underestimate the calories a human body needs to function properly.
Many guys try to survive on 2200 kcals per day. That would work perhaps for a girl in her teenage years but not for a grown male with a crazy work and workout schedule. Furthermore, many people into “fitness” often do crazy (intermittent) fasting and/or keto protocols. They love “how energetic” they feel. Well, that is your cortisol being through the roof because you are starving. However, down the line, many severely crash because their hormones do so. In many cases, they never recover.
Maintaining too low levels of body fat percentage, prolonged caloric restriction, intermittent fasting, a ketogenic diet, excessive exercise, etc. can all lead to severe hormonal imbalances — all via the same mechanism.
This chronic restrictive eating often drives the hormone leptin to very low levels. This is esp. true if body fat is already low. Leptin is a master control hormone and whenever it falls to low levels, this completely turns our endocrine system upside down.
Leptin is a hormone secreted by adipose cells (fat tissue) and its levels depend on how “full” these fat cells are. Thus, it can be considered the body’s “fat report”. Among other things, high levels of leptin (= lots of body fat) signal to the hypothalamus “You have plenty of fuel reserves. Go ahead with being energetic and breeding,” and low levels of leptin signal “We have a fuel crisis. Conserve resources. Stop breeding.” Evolutionarily, low levels of leptin were a signal for starvation. The hypothalamus responds by shutting down the thyroid and reproductive hormones while ramping up stress hormones. For example, in both genders, GnRH-secretion drops to very low levels. Females often lose their periods (which is an all-or-nothing thing) and male sex hormones take a major hit as well.
Note: Low levels of body fat cause low levels of leptin. Whenever fat stores are actively diminishing, levels of leptin decline even more (regardless of baseline level of body fat). Furthermore, diets low in insulin (esp. fasting, very low carb diets) cause the most extreme decline in leptin levels -and the decline is even greater than the combined decline from low levels of body fat and the (independent) decline from actively diminishing fat stores. Firstly, insulin is a potent stimulator of leptin secretion (regardless of caloric intake). Secondly, insulin directly stimulates sex hormones and thyroid hormones at the level of the hypothalamus. Therefore, the worst-case scenario would be low levels of body fat + actively losing body fat + very low levels of insulin. In this instance, severe hormonal imbalance is almost certainly a given.
There are thousands to millions of people out there in this chronic state of “fitness anxiety”, bordering on orthorexia and anorexia. By restricting calories for long periods of time, thyroid hormones drop, sex hormones drop, and over time their adrenal axis burns out leading to low levels of cortisol. Furthermore, many often drink lots of coffee, putting additional pressure on the adrenals. All this causes energy levels, mood, immune function to take a hit and leads to neurotic and obsessive mental states ( → Minnesota starvation experiment). There is no value in looking good but feeling like crap all the time. For more about (intermittent) fasting, ketogenic diets, and caloric restriction and how these diets can mess with mental health, personality, hormonal health, read here: A Diet That Works Well For Everyone.
Sometimes all that is needed to restore hormonal health is to eat a sufficient number of calories in order to gain some body fat and raise levels of leptin and insulin. Does eating enough and gaining some healthy amount of body fat restore hormonal balance for everyone? No. Eating disorders (or long periods of insufficient caloric intake) can “imprint” on your endocrine system by affecting gene methylation as well as hormonal generators within your hypothalamus. There is a large number of people that destroyed their hormonal balance permanently by severe or prolonged dieting during adolescence and early adulthood. Most of them without being aware of it. The road to recovery is long and painful in such cases. Sometimes gaining a little fat and eating enough will somewhat improve hormones, though unfortunately, many do never recover their baseline hormonal profile. In this case, hormone replacement is (often) the only thing that helps.
Note: Most participants of “The Biggest Loser” never recovered their baseline leptin levels resulting in permanent hormonal imbalances. In the months after the show, most of them returned to their unhealthy baseline bodyweight, but were now burning around 500kcal less than before -despite having the same body weight. Their period of extreme stress and starvation likely did cause permanent changes in gene methylation patterns in various parts of the brain. There is one way to kickstart metabolic processes again and to break this vicious cycle of permanent “starvation mode” turned on. However, if approached incorrectly, it can be dangerous. This is why I do not lay out the protocol to do so here in the open. If you are interested you can contact me via the email provided below.
8. General and practical aspects of hormone optimization
Note: In this section I talk about the general and some practical aspects of hormone replacement. However, different hormones are different. All these points will be covered in much greater detail in the respective articles about how to optimally replace these hormones (Cortisol, Thyroid, Male Sex Hormones, Female Sex Hormones, Growth Hormone, Non-Major Hormones).
- How to get started
- Why hormone deficiencies are often overlooked
- Blood tests
- Reference ranges
- Blood tests are not enough
- With hormones, it is all about balance
- We are all a little different. There is no “one-size-fits-all”.
- How to start therapy: Start low & go slow
- How long until the benefits will be evident?
- Will I develop a tolerance?
- Should dosages be kept the same all the time?
- Stopping hormone therapy requires tapering down slowly
- Finding the right doctor
How to get started?
All of the major hormone deficiencies (thyroid, sex hormones, cortisol, growth hormone) have partially overlapping signs and symptoms (e.g. fatigue, low libido, bad sleep, brain fog, low motivation, depression, anxiety, weight gain, etc.). Furthermore, these signs and symptoms are shared with many other non-hormonal conditions as well. Therefore, by considering only physical signs and symptoms it is often almost impossible to determine whether a hormone is deficient and certainly not which one. Deciphering signs and symptoms adequately requires extensive clinical experience.
For these reasons, I believe that getting a thorough hormonal panel is incredibly useful and perhaps the best starting point.
However, let us look first at why hormone deficiencies are often overlooked by mainstream medicine.
Why hormone deficiencies are often overlooked
Not only are hormone therapies neglected by mainstream medicine, but hormone deficiencies are also often overlooked.
Subspecializations in medicine have produced doctors who are often unable to detect even blatant signs of hormone deficiencies (esp. cortisol deficiency), resulting in great and unnecessary suffering. They claim nothing is wrong and/or give out stimulants, antidepressants, or send their patients somewhere else. Worse still, in some cases, doctors even assume their patients are “mental”. So, they suggest psychotherapy. Psychotherapy certainly helps in terms of accepting one’s state but it will not give anyone the energy back!
What many patients need is safe, physiological hormone replacement, often just temporary hormonal support necessary for adequate recovery. Unfortunately, there are very, very few doctors out there that recognize this.
So why do doctors not recognize hormone deficiencies?
- Firstly, the (sub)specializations in medicine (and undertraining in endocrinology) have left us with doctors who are often blind to everything out of their narrow domain (e.g. unable to detect even blatant signs of hormone deficiencies).
- Secondly, results of laboratory tests often show our hormone levels to be “normal” because hormone levels fall within the medical reference range. When doctors look at your blood work, they usually treat it as an “all-or-nothing” issue. If we fall anywhere within the “normal” range, a doctor will tell us everything is great. However, if we are just slightly above or below an arbitrary number, they will tell us something is wrong. In fact, many people who seek out doctors for problems with hormone deficiencies at their root cause, do not fall below the medical reference range and thus often fly under the radar of the current medical system of doctors who just look at values that are flagged. Their values come back “normal”. However, normal for someone 30 years their senior.
Back to blood tests. Trying to figure out hormonal imbalances purely based on signs and symptoms -let alone starting treatment- is like playing darts blindfolded. Therefore, before doing anything, getting a blood test measuring a few key parameters is highly useful. In my opinion, everyone should get a complete hormonal panel at least once in their life. Why this is not done by default in most health care systems is beyond me. While the cost is comparably small, the opportunity cost of not doing this is extremely high. Not just financially.
Note: If your health provider does cover for extensive blood testing and your physician is able to order these for you, go ahead. However, if you have to pay for the blood tests yourself, before spending a large amount of money on a doctor and then on blood tests (often including many quite useless parameters), I recommend getting the blood tests yourself.
These are the serum values I consider indispensable.
For general health:
Differential blood count, vitamin B12, Apo B, ALT, AST, CRP, uric acid, ferritin (only valid if CRP is 0), albumin, HBA1C
- Thyroid: TSH, fT4, fT3 (optional: rT3)
- Sex hormones: LH, FSH, testosterone, free testosterone, SHBG, estradiol (if you are female, results strongly depend on where you are in your cycle) (optional: DHT, progesterone)
- Growth hormone: IGF1
- Other hormones: vitamin D (yes, it is a hormone)
- Adrenals: DHEA-S (optional: ACTH, 24h-urinary free cortisol)
The following can be said about blood tests in general: Blood tests measure what is in the blood. They do not measure cellular action, which is what it is all about. Therefore, when it comes to endocrinology, blood values matter just as much as physical signs and symptoms and they must not be interpreted in isolation. It is quite common that someone with adequate blood values is hormone deficient (and that someone with deficient blood values is not deficient at a cellular level). More info on that later.
Note: When it comes to testing hormones, some hormones are easier to test for than others. For example, when it comes to testing thyroid hormones, blood tests are not that useful because blood levels are often highly discrepant with cellular action. On the other hand, when it comes to sex hormones, blood tests are quite useful and somewhat accurately reflecting tissue status (however, even with sex hormones, blood tests must not be interpreted in isolation). When it comes to cortisol -a deficiency in which is common, misunderstood, and neglected- unfortunately, blood values give us the least insight. However, quite a lot can be said about someone’s adrenal status by looking at thyroid status, blood pressure, blood pressure amplitude, resting heart rate, average body temperature, and circadian differences of the amplitudes in body temperature. In combination with specific signs and symptoms, someone’s glucocorticoid status can be inferred quite accurately by integrating all of these even without any additional “objective” tests (e.g. ACTH, 24-urinary cortisol, free cortisol (serum), transcortin, saliva tests).
What about saliva and urine? In my opinion, urine and saliva tests are of little value. Their only advantage is convenience. There are simply too many variables that can influence results between one day and the next in the same patient, let alone from patient to patient. Thus, in case someone wants to rely on urine or saliva testing two things need to be kept in mind:
- Tests need to be repeated multiple times on multiple days to reduce intra-personal variability (e.g. hydration status, caffeine).
- Individual test results must not be compared to other people because there are just too many factors regarding inter-personal variability (e.g individual vasoconstrictive properties in the salivary capillary beds, binding proteins, etc.)
Reference ranges are statistical ranges that cover 95% of the natural variation found in a population. However, certainly more than 5% of the population have hormones bad enough to warrant intervention.
When it comes to levels of different hormones, everyone is falling somewhere along a huge spectrum of countless different possible permutations. Most of us are by definition average for levels of the major hormones, which are likely to fall somewhere around the middle of a bell curve distribution.
Despite most people’s hormones are not being “pathological” (i.e. outside the medical reference range), merely falling somewhere within this range is not “optimal”. Many people by whom this statistical range is established, live lives of quiet desperation, and if you go by statistical normality, you are likely to become overweight, unhealthy, unhappy, anxious, or depressed. Not necessarily what I would want for myself in the only life I can be sure of having.
A quick note about binding proteins: Ideally, binding proteins (SHBG, CBG, TBG, IGFBP-3, albumin) should be around the middle but if the free target hormone (T, E2, fT3, fT4, IGF1, C) is where it should be, it does not matter that much. Just to note, T3 and E2 increase the synthesis and levels of all binding proteins, while androgens, IGF1 and cortisol reduce their synthesis, which sometimes can skew results.
With all hormones, levels vs. benefits follow an inverse U-shaped curve (although this curve is skewed slightly to the right for all of the major hormones). Most risk comes from deficiency or excess (e.g. overreplacement). Where the optimum of a single hormone lies, depends on two things. Firstly, interindividual differences (more on that later). Secondly, the balance of other hormones.
A common misconception is that more is better. Nothing could be further from the truth. Having one hormone at levels too high carries risks (e.g. elevation in blood pressure) and side effects (e.g. insomnia). For example, having thyroid hormones too high can make you hungry all day, which is super distracting to whatever else you are doing. For many, going too high in testosterone will increase libido to a point, where they waste a lot of time only thinking about sex. Going too high in cortisol will impair slow-wave-sleep (and much, much more), and so on. For more info on the risks and side effects see the respective guides (Cortisol, Thyroid, Male Sex Hormones, Female Sex Hormones, Growth Hormone).
What is the optimal target range? This is a question that is unanswerable because everyone is different (more on that below). Furthermore, blood tests must not be interpreted in isolation (more on that below as well). If you are below the age of 30 and you are in the lower third of the reference range (and certainly if you are in the lower quarter), chances are high that the risk of intervention is much lower than the risk and opportunity cost of inaction. Personally, for most hormones, I aim for the upper third of the youthful reference, ideally around the 75th percentile. In my opinion, the lower end of the upper third of the youthful reference range delivers the best tradeoff between health, performance, wellbeing and longevity and as a rule of thumb, this is a good target range to initially shoot for, given that other hormones are somewhere around that percentile as well. Dosages can then be adjusted based on individual preferences and needs (e.g. signs and symptoms of deficiency or excess).
Blood tests are not enough
While blood tests are certainly helpful and a great starting point, they have a major downside: They just measure what is currently in the blood. However, hormone levels in the blood do not tell us much about cellular action, which is the only thing that matters.
Because of this, there is no definite cut-off number on a blood test that can tell us in a clear-cut way, whether we are deficient in a specific hormone or not. Therefore, blood tests must not be interpreted in isolation and when it comes to endocrinology, the symptoms and physical signs matter just as much, perhaps even a little more, than numbers on a paper.
Therefore, to determine a deficiency, we need to look at physical signs, symptoms, and blood values together. We need all three. This point is widely misunderstood and is one of the most important points in this article.
To adequately determine hormonal status, all of the following three are needed:
- Blood values
- Physical signs (=what a doctor can see without you telling him) (e.g. dark circles, hair or skin problems, puffy face, etc.)
- Symptoms (=what a doctor cannot see unless you tell him) (e.g. type of fatigue, brain fog, urinary incontinence, etc.)
Unfortunately, hypothyroidism, hypocortisolism, hypogonadism, and growth hormone deficiency all have (partially) overlapping symptoms. For example, a deficiency in every one of these hormones will cause fatigue, mood issues, low libido, bad sleep, a suboptimal immune system, etc. Thus, without also taking into account physical signs and blood tests it is often impossible to determine a hormone deficiency based on symptoms alone. In general, the symptoms of thyroid deficiency overlap with signs and symptoms of cortisol deficiency (e.g. lethargy, fatigue at night and in the morning, taking forever to wake up, brain fog, etc.). On the other hand, the signs and symptoms of sex hormone deficiency overlap with the signs and symptoms of GH deficiency (e.g. less vigor, less zest for life, anxiety, fat gain). For more info on specific signs and symptoms see the respective articles about the individual hormones (Cortisol, Thyroid, Male Sex Hormones, Female Sex Hormones, Growth Hormone, Non-Major Hormones).
We are all (a little) different. There is no “one-size-fits-all”.
While everyone is different and there are exceptions, for many people, having levels around the 75th percentile of the youthful reference range often delivers a good tradeoff between health, longevity, and wellbeing. However, we are all a little different and there is no “one-size-fits-all”.
All of us have differences in binding proteins, metabolism, cellular sensitivity, function and quantity of receptors, nuclear cofactors, gene methylation patterns, etc. Because of these interindividual differences, optimal hormone levels often differ between individuals, and therefore, hormone optimization needs to be custom-tailored to each person individually, whereby attention has to be paid not only to where a number falls on a range but also to how that number relates to physical signs and symptoms.
For example, my testosterone at 800ng/dl is not your testosterone at 800ng/dl.
Unfortunately, there is no definite indicator (e.g. a specific sign or symptom) that can tell us in black and white whether a hormone “needs” to be replaced or not and/or dosages changed. Therefore, hormone optimization is as much an art as it is science.
When it comes to hormones, the right or wrong choice can make or break your life. Due to my unique story, extensive knowledge, and personal experience, few people know as much about hormones, all their interactions, and specifics. Using individualized hormone optimization, lifestyle changes, diet, supplements, and sometimes pharmaceutical drugs, I have worked with hundreds of people around the world and was able to solve diverse problems such as chronic fatigue, fibromyalgia, brain fog, libido issues, anhedonia, depression, anxiety, ADHD, body recomposition, fixing metabolism after a starvation diet, infertility, resetting the HPA-axis to a higher setpoint, reversing thyroid resistance, multiple hormone balancing, etc. My goal is not to just patch up symptoms (as most doctors do) but to holistically understand a case with its history, health, situation, and context. For inquiring about your own situation, contact: email@example.com
Hormones need to be balanced with each other.
If one member of the orchestra is off, the orchestra as a whole does not sound good. This is similar to the endocrine system and hormones too need to be balanced.
For example, having high levels of testosterone requires somewhat high levels of estradiol as well, having very high levels of thyroid hormones while having a low level of cortisol is a recipe for disaster, etc.
To maintain good energy, mood, health, libido, sleep, emotional wellbeing, etc. we need to have adequate levels of all the major hormones. If even one of these hypothalamic hormones is off this will be our limiting factor and the effects of all the other hormones will be off as well- and so will our energy, mood, physiology, and health.
When it comes to balancing hormones, it can become very tricky very fast. Turn one gear and many others are set in motion as well. When it comes to hormone balancing, there will be some (educated) guesses and trial & error involved. An experienced doctor greatly helps (if we are lucky enough to find one).
Using multiple hormones in small, physiological doses is safer than (ab)using a single hormone in high, unphysiological doses.
In general, most people start with the replacement of just a single hormone. However, often results do not manifest as they expected or wished. Many then try to compensate for multiple hormone deficiencies (that they are not aware of) by increasing the dosage of whatever hormone they are already replacing. However, instead of over-replacing and abusing a single hormone in high and unphysiological doses -which is quite common, it is much healthier, safer, more natural, and more effective to add one or more other hormones in small and physiological doses.
Unfortunately, the overreplacement of any hormone is tempting because it might ”feel good” and does often indeed improve some symptoms (esp. energy levels). Because some symptoms improve, many people assume they simply have not raised their dosage high enough. However, the overreplacement of any of the major hormones (e.g. cortisol, thyroid hormones, testosterone) will almost always improve energy levels and mood, which will almost always improve symptoms. Therefore, every single one of the major hormones can be (ab)used as a stimulant and masking-agent if dosages are high enough. However, over the long run, any form of overreplacement -whether intentional or not- carries more risks than benefits and likely comes with a tradeoff of an increase in wellbeing and performance in the present for health and longevity in the future. In my opinion, in most cases, this is a tradeoff not worth making.
Example: For example, most males overly fixate on testosterone -often to the exclusion of other hormones. However, thyroid and adrenal hormones are just as important, perhaps even more so. Personally, out of these three, I noticed the least changes/improvement from TRT. While testosterone is certainly important, it is just one member of the orchestra. If someone finds out that their testosterone is low, many go on TRT and feel somewhat better. If their energy levels (and other symptoms) do not improve as they wished, many tend to raise their doses of testosterone -often repeatedly. Doing this, some symptoms improve (e.g. energy, mood) and therefore to them, it seems obvious that they were still deficient. In reality, though, they often were not and the suboptimal results frequently were due to suboptimal thyroid and/or adrenal hormones. If the thyroid or the adrenals are deficient, injecting all the testosterone in the world, will not make someone feel (or function) much better. On the other hand, after thyroid hormones are balanced, the dosage of testosterone can often can be reduced because its effects are suddenly much more potent.
When it comes to interventions, many of us have the mindset of “one intervention is safer and healthier than two.” However, when it comes to hormones, unfortunately, this mindset leads us astray and is partly the reason for many risks and side effects (and therefore “the hormone scare”) associated with hormone therapies.
Once other hormones are balanced, dosages of hormones that the individual is currently replacing, can and often need to be reduced drastically, thereby also avoiding many risks and side effects associated with hormone therapy. For example, after adrenal hormones are balanced, the dosage of thyroid hormones -given the patient was able to tolerate thyroid hormones at all- can often be reduced by around 30%-50% because the effects are suddenly much more potent. Similar things hold true for sex hormones after thyroid hormones are balanced, or for thyroid hormones after growth hormone is balanced. However, by how much dosages need to be reduced is highly individual. Therefore, whenever any changes are made, it is advisable to monitor signs and symptoms and also check blood values around 1 month after treatment adjustment.
Why for some effects multiple hormones are needed. For some effects (e.g. libido, energy levels, thermoregulation) adequate levels of not just one but multiple or even all of the major hormones are needed. The receptors for androgens (AR), estrogens (ER), glucocorticoids (GR), thyroid hormones (TR) are all transcription factors. Transcription factors are proteins that -once activated by an agonist- bind to specific hormone-response elements in the promoter regions of hundreds or even thousands of genes throughout the genome to increase (and rarely decrease) the rate of their transcription (gene expression). Most genes are modulated by a combination of multiple transcription factors and how much these genes are expressed, depends on which transcription factors are present and in what quantities. In terms of how much a certain gene is expressed, this combinatorial binding of multiple transcription factors (TFs) on the same promoter region can be additive, less than additive, synergistic, or follow an all-or-nothing response. In the last case, if not a full specific set of transcription factors is present (e.g. both the GR and the TR), the gene will not be transcribed at all -at least not in a meaningful way. In the same way a necklace is just as strong as its weakest link, this lacking transcription factor is the limiting factor then. For example, adequate libido requires both the presence of androgens and estrogens and cortisol. If either of these is lacking, libido will be as well. For more info on the science of hormones, read The Science Of Hormones: An Unconventional Introduction.
40 percent of adults experience daytime tiredness severe enough to interfere with their daily activities. They are always tired or even exhausted. Naturally declining hormones are sometimes the root cause and in many cases certainly a contributing factor. We all know those people who seem to be able to live life to the fullest (full of energy, experiencing intense emotions, cognition, health, drive, and motivation). Well, in order to live a life like that a great hormonal profile is not enough but certainly a prerequisite. In general, the average level of our hormones determines our energy levels. If hormones are to blame, we can sleep-eat-exercise-repeat all we want but our fatigue will not get much better.
For good energy levels, all of the major hormones (sex hormones, stress hormones, thyroid hormones, growth hormone) need to be at adequate levels. If even just one of these hormones is off, this will be our limiting factor. However, each hormone deficiency is associated with a specific kind of fatigue.
- Thyroid hormones set the idle state (the “baseline”). Click here.
- Cortisol is the gas pedal (the “punch”). Click here.
- Growth hormone and IGF1 ensure recovery (the “stability”). Click here.
- Sex hormones give the drive and motivation (the “spice”). Click here.
Note: How much “energy” a person has, is to a large extent determined by thyroid and adrenals hormones. Even though the symptoms of cortisol and thyroid hormone deficiency overlap, their fatigue feels very different. With low cortisol, people feel “like crap” in the morning, whereas with low levels of thyroid hormones, people simply feel groggy and sleepy but not “like crap”. With low thyroid hormones, people get lethargic and sleepy at rest, whereas with low levels of cortisol people feel best when resting. While thyroid sets the “idle” for the system, cortisol is the “gas pedal”. In fact, optimizing thyroid and/or adrenal hormones is often enough to “give people their life back”. To learn more about how the different kinds of fatigue “feel” differently, read here.
The four most common issues that can cause chronic fatigue despite good hormones:
- Sleep problems: For example, insomnia, sleep apnea, coffee addiction, stimulants, anxiety.
- Gut issues: For example, leaky gut, SIBO, insensitivity to gluten/eggs/dairy -only in some people, NSAIDs, candida overgrowth, a low fiber diet, alcohol, H. pylori, specific food intolerances and/or insensitivities. For how to treat gut issues, click here and read the specific section on microbiome and gut health.
- “Sickness behavior”: Usually due to any chronic inflammatory state (e.g. autoimmune disease) or an ongoing infection (e.g. Lyme disease). The resulting hypercytokinemia acts at many sites in the brain, reducing the signaling of arousal transmitters (esp. noradrenaline, dopamine).
- Nutrient deficiencies: For example, dehydration and/or low blood pressure, hyponatremia, magnesium, zink, selenium, iron and/or anemia, vitamin B12.
If one or more of these issues is present, hormones cannot give adequate relief and/or would need to be (ab)used in high doses as stimulants and masking-agents.
How to start therapy. Start low & go slow.
As mentioned, hormones act directly on gene expression. Therefore, the effects of hormones change the internal machinery of our cells. Consequently, whenever hormone levels change, tissue structure and function will change. By starting with low doses (e.g. one-fourth of the presumed target dose), cells and tissues will not be thrown off balance as much because they aren’t forced to adapt and change as quickly to the new balance of hormones they are exposed to and to the altered levels of different proteins they now express.
Starting with a dosage too high or increasing the dosage too fast comes with increased side effects, most of which could be avoided -or at least drastically reduced- by following the start-low&-go-slow approach.
A good, generic way that works for many is to start with 25% of the presumed target dose and then gradually increase the dosage over a 2 month period.
Route of administration
Every cell in our body has a receptor for all our major hormones. These receptors are saturated depending on the local concentration of the hormone. This means that:
- With oral administration, a larger dose will act in the duodenum and esp. liver. Therefore, hydrocortisone, thyroid hormones, ethinylestradiol, oral androgens, etc. will exert disproportionate effects in the liver which is often reflected in changes in metabolic health.
- With injection (i.m. or s.c.) there will be a local effect as well. For example, injecting insulin will lead to the deposition of fat tissue around the injection site, whereas injecting growth hormone will lead to localized lipolysis (and possibly localized soft tissue, muscle, or bone growth). Injecting testosterone directly into a muscle will lead to localized muscle growth as androgen receptors are more saturated at the injection site compared to other sites in the body.
- The same holds for transdermal administration. For example, transdermal estradiol will stop hair growth underneath the site of application. Transdermal cortisol will exert localized anti-inflammatory effects, cause skin atrophy and have bleaching effects. Transdermal testosterone will stimulate localized hair growth, etc.
Optimal routes of administration:
- Oral: Thyroid hormones, cortisol (hydrocortisone, cortisone acetate), fludrocortisone, progesterone, DHEA, vitamin D
- Sublingual: Melatonin
- Injection: Testosterone, HCG, GH
- Transdermal: Estradiol
How long until benefits will be evident?
Benefits and changes take time. We need to be patient and give our cells and tissues the necessary time to adapt both structurally and functionally to the altered levels of hormones. While some benefits will be immediate, most changes require a wait of around 3–4 months to fully materialize.
Note: Onset of changes with hormone replacement: Cortisol (hours to days) >>> thyroid hormones (weeks) > sex hormones (weeks to months) > growth hormone (months).
Will I develop a tolerance?
The use of exogenous hormones is always accompanied by some endogenous suppression (more about this in Section 9). However, endogenous suppression is not the same as tolerance.
Hormones act on nuclear receptors (and not on transmembrane receptors like most pharmaceutical or recreational drugs do). Therefore, hormones directly alter gene expression, which is the most downstream level possible. To these effects, there is little to no tolerance. However, there will be some tolerance to some effects on neurotransmitter systems (e.g. increased levels of dopamine). For more info on the science of hormones, read The Science Of Hormones: An Unconventional Introduction.
Should dosages be kept the same all the time?
The hypothalamus adjusts hormone levels depending on circumstances (e.g. an increase in cortisol during times of starvation or infection or stress, a seasonal adjustment of sex hormones depending on light input, a reduction of thyroid hormones in times of caloric restriction, etc.). Despite our hormones being naturally somewhat dynamic, in general, I recommend keeping dosages the same and constant after a stable replacement protocol has been found. The endocrine system is incredibly multi-layered and complex. By varying dosages of a single hormone, almost all of the other major hormones will, to some extent, be influenced as well. Therefore, varying dosages does not just require diligent monitoring of signs, symptoms, and blood values but likely also necessitates some counter-balancing and tinkering with other hormones.
For example, an increase in thyroid hormones will cause an increase in cortisol needs and an increase in levels of estradiol. An increase in growth hormone will cause a greater breakdown of cortisol ( → cortisol needs to be increased) and also an increased conversion of thyroxine to triiodothyronine ( → thyroid hormones need to be decreased), which in turn will then affect sex hormones ( → dosages of sex hormones need to be changed as well). There are many, many, many more examples with highly complex second-and third-order consequences occurring as a result of a change in one of the major hormones. Furthermore, how much other hormones change is highly individual and incredibly hard to predict.
Here are some exceptions when a temporary dosage adjustment can be helpful:
- A slight decrease in thyroid hormones during the summer months (e.g. 0.25 grains of NDT less). For more info on thyroid hormones read here.
- A slight increase in dosage of T3 during a period of active weight loss to make up for the central thyroid shutdown as well as the increased peripheral thyroid resistance
- A slight increase in GH to speed up healing and recovery from injury or surgery
- An increase in glucocorticoid dosage in times of sickness or extreme physical or mental stress. For more info on cortisol, read here.
Note: Changing dosages of hormones depending on circumstances requires an integrated understanding of endocrinology and physiology. I strongly advise against doing this without the help of an experienced professional because turning one gear will set many others in motion as well.
Whenever any changes are made (e.g. dosage, products), it is recommended to monitor signs, symptoms, and blood values. Regarding the latter, we should check blood levels not only for the hormone to which changes were made but ideally the full hormone panel.
Note: As mentioned above, following changes to a single hormone, multiple other hormones (slightly) change due to the hormonal impact on binding proteins, aromatase, 5a-Reductase, deiodinases, metabolizing enzymes, the hypothalamic feedback machinery, cellular uptake, etc.
Many changes are due to changes in gene expression, which usually take around 2–4 weeks to reach stable effects. Therefore, after making any changes, we should wait about a month before we judge the effects and/or before we follow-up with a blood test because if done earlier than that, many things will likely still be subject to change. Furthermore, how much individual hormones and/or effects change, depends on genetic, endocrinological, metabolic, and lifestyle factors.
The three most important changes that are of great clinical significance:
- Adding/increasing thyroid hormones: aromatase will be stimulated and therefore estrogen will increase (sometimes requiring an aromatase inhibitor), SHBG will increase and therefore levels of total testosterone (falsely) higher, DHEA-S and adrenal steroids will increase for most people (if they do not, the addition/increase in thyroid hormones is often not well tolerated)
- Adding/increasing growth hormone: deiodinase II will be stimulated and therefore fT3 will increase (often requiring a dosage reduction of thyroid hormones), HSD-II will be stimulated and therefore area-under-the-curve levels of cortisol will fall (often requiring an increase in dosage of cortisol)
- Adding/increasing cortisol: thyroid hormones will be potentiated in their effects (often requiring a decrease in thyroid hormones)
- There are many more. For more information, scientific explanations, and what to practically do about it, see the respective guides: Cortisol, Thyroid, Male Sex Hormones, Female Sex Hormones, Growth Hormone, Non-Major Hormones
How to stop hormone therapy
With the use of any exogenous hormones, there is negative feedback to the hypothalamus and the pituitary, which reduces or even completely shuts down the signals sent to the peripheral endocrine gland. In the short term, the gland simply slows (or ceases) production but over time some atrophy does happen (depending on the dosage).
Therefore, stopping the use of hormone therapy suddenly can have dangerous consequences. Therefore, if someone -for whatever reason- wants to come off therapy, a gradual, progressive dosage reduction is required (tapering). This will allow sufficient time for two things:
- Firstly, the hypothalamic hormone generators need to pick up again, which takes some time. For example, after testosterone therapy is stopped, GnRH → LH/FSH will remain suppressed for some time after.
- Secondly, the peripheral endocrine glands need to hypertrophy again to be capable of increased hormone output meeting the increased hormone demand. For example, after testosterone therapy is stopped, the testicles need to hypertrophy again to be able to deliver the appropriate output to match the increased levels of LH/FSH.
Together, both of these processes usually take weeks to months, during which one might need to accept living in a state of temporary and partial hormone deficiency. The dosage reduction and the rate of tapering should be guided by signs and symptoms and is therefore highly individual.
As long as normal doses are used, people almost always recover completely after a few months of stopping hormone therapy. However, even though rare, it is possible that some people do not. For more info on that, read Section 10.
Finding the right doctor
In the same way a hormonal imbalance left untreated for too long can destroy a life, the appropriate, therapeutic use of hormones is the most efficient and effective way to improve every facet of it. Therefore, the quality of doctor advice can make or break your life. Unfortunately, when it comes to hormones, good doctors are incredibly rare and very hard to find. In general, most doctors are 20 years behind the science. Even the ones who do know the science were first and foremost trained not to harm. Therefore, even if they would replace hormones differently in themselves or their families, for treating patients, the vast majority of them would rather stick to the (suboptimal) guidelines optimized for safety -as any slight deviation from them could cause the loss of a medical license.
Even if a doctor has helped over a thousand people and just a single person suffers from a severe adverse event arising from treatment against the recommendations laid out in the guidelines, the doctor could lose his license. Given doctors usually treat thousands of patients throughout their career, this is a risk not worth taking -even though doctors know quite well that guidelines generally make blanket statements and do not stratify which patients are likely to benefit or are harmed.
Example: Let’s say we have 100 hypothyroid patients. In modern endocrinology, all of them will be treated T4-only therapy. However, most of them would benefit if some of the T4 is substituted by some T3 (e.g. 4:1). Let’s say that 5 of these 100 patients would have some side effects and for 1 person the side effects could be severe (esp. older people with weak hearts and bones). For mainstream medicine, this is not acceptable and they’d rather treat all 100 people suboptimally compared to risking a single severe adverse event. Therefore, the guidelines are optimized for safety according to the principle “primum non nocere”. However, the overfocus on this principle causes a colossal amount of potential wellbeing to be left behind and, from a utilitarian point of view, the area-under-the-curve-wellbeing to be much smaller compared to what it could be -ultimately condemning millions of people worldwide to be, live and feel vastly below their potential.
Despite all this, there certainly are good doctors out there who do know the science and who do take the necessary time and effort to look at a patient in a holistic way (history, health, context, situation, lifestyle, needs, preferences, etc.), custom-tailoring and individualizing treatment instead of just patching up symptoms (as most doctors do) and protecting themselves by patient consent forms for off-label use. Unfortunately, these doctors are incredibly expensive and/or incredibly hard to find. Thus, finding and choosing a good doctor requires a lot of money and/or a lot of luck -likely both.
Furthermore, if someone approaches a number of different endocrinologists, longevity doctors, or functional medicine practitioners, chances are high that all of them will treat somewhat differently (e.g. yes/no, therapy of choice, dosage, multiple hormones), based on their opinion and experience.
So, how to find the right doctor? Unfortunately, I cannot give you the “right” answer. It surely is the case that for most people, for the delicate balancing of multiple hormones, an experienced doctor is almost a must-have. However, if we happen to be unlucky enough to find and trust the wrong doctor, this can have devastating consequences. Not just for our own lives.
Note: Knowing this, personally, I choose to do it all myself despite being supervised by doctors. However, if I took what they prescribed, not only would that be highly suboptimal for my quality of life but also for my health and longevity. They would treat my thyroid with just T4. They would use 30mg HC for adrenal treatment, which is way too high and only prescribed to patients out of fear of a potential adrenal crisis. They would bring on me Testogel (transdermal testosterone) for replacing sex hormones because “it is much more convenient than injections”. They would also tell me: “No growth hormone, because you do not need it”. So, in summary, they would be replacing every single hypothalamic axis suboptimally. In my opinion not just “suboptimally” but in many respects their approach is complete bovine excrement.
Sources for hormones
Hormones are prescription drugs. As is the case with all other prescription drugs, whether or not you get a prescription depends on your doctor and whether or not he thinks your case warrants hormone replacement.
Personally, I get all of it prescribed from doctors, which is certainly the easiest thing to do -esp. if your doctor is somewhat knowledgeable about hormones in addition to that. Sourcing hormones without a proper prescription can be tricky. On the black market, there are a lot of “fake” hormones (bad or inconsistent quality, impurities, being something completely different compared to what is on the label, differences in dosages between batches and even single pills from the same batch, etc.). Personally, never in my life would I risk putting anything potentially impure, mislabelled, dangerous into my body by getting non-pharmaceutical grade hormones. Hormones are powerful molecules and getting them from a sketchy source is like playing roulette. The Russian version.
Other than protein hormones (e.g. growth hormone), hormones are quite cheap because they are easy to manufacture and also because they cannot be patented. For example, the protocol laid out above costs me around 300 $ per month (of which 200 $ is for the growth hormone and 100 $ for all the rest). This is not that much considering how much money many of us spend on supplements for perhaps a 5% effect size in comparison to hormones. Downstream the extra mood, energy, focus, health, willpower, social skills -all of them compounding over the years- will likely pay me back way more than that financially -regardless of the priceless gains in well-being and life-enjoyment.
For most people, added to this, is the cost of a doctor. We have beautiful homes, clothes, cars and spend a lot of money on them. Often much more money than we spend on ourselves. Even if your doctor costs over 10k a year, if your income is tethered to your performance, you likely make this money back easily, given the compound interest and downstream effects of daily increased energy, mood, health. On the other hand, when it comes to hormones, bad initial decisions (e.g. from cheap, low-quality doctors) can potentially be extremely costly down the line.
9. How to replace individual hormones. A quick step-by-step guide.
Before doing anything else: we should get our sleep and diet in order.
Improving diet and sleep will often improve hormones naturally. Not just that -often even full-blown deficiencies will correct themselves. It would be stupid not to have tried this first before pulling the trigger on potentially life-long hormone replacement.
For more info on diet, see here: A Diet That Works Well For Everyone.
Step 1. Learn about hormones. Test your blood.
- Educate yourself. Learn about physiology. Learn about endocrinology. Learn about signs and symptoms of hormone deficiencies.
- Blood tests (see above). Also measure blood pressure, pulse, temperature and track them for a few weeks.
- Look out for signs and symptoms of hormone deficiencies.
Beware: Many want results now. This mindset might work for stimulants but when it comes to hormones, this is the wrong approach. Our goal is to achieve optimal energy levels, mood, and health. At baseline. Take your time. We are in for the long game, a marathon, not a sprint.
Step 2. Decide which hormones to replace
- Balance: For adequate health, performance, wellbeing, all of the hormones must be at adequate levels.
- Which hormones to skip: If a target hormone is well in range (i.e. above the 50th percentile of the “normal” reference range on a blood test) it is unlikely (but not impossible) that this is causing our signs and symptoms. To get started, skip these for now.
- Is a single hormone enough? Many people are fine with replacing only a single hormone. However, many others are not. For approaching the “optimum” -whatever that means to you- a single hormone is often not enough and multiple hormone replacement is often needed (esp. if someone is over 40). This is just the way it is. As mentioned above, many of us follow the mindset of “one intervention is safer and healthier than two.” When it comes to hormones, however, this mindset leads us astray -esp. when people start overreplacing and abusing a single hormone to compensate for a deficiency in others. It is much healthier, more natural, more effective to balance multiple hormones instead, using small and more physiological doses of these.
- Thyroid and sex hormones can often be replaced in isolation. Thyroid and sex hormones are the most common axes, whose deficiency occurs in isolation, and which can also be replaced in isolation.
- Start with thyroid hormones: If multiple hormones are deficient -unless someone has severely low levels of cortisol- it is both easiest and safest to start with thyroid hormones. Furthermore, optimizing thyroid hormones will often improve levels and action of all the other hormones. For more info on thyroid hormones, read here.
- For energy levels, it is not just hormones: Even though an adequate hormonal profile is the most important factor when it comes to ensuring good energy levels if any of the following is an issue, fatigue will hardly be improved by even impeccably balanced hormone therapy: sleep issues, gut issues, inflammatory issues, nutrient deficiencies. For more info, see the section “Energy levels” above.
- Throughout the journey: lots of research → educated guesses → trial and error → symptoms, signs, blood tests → repeat.
- Monitoring and follow up: “Listen” to your body (i.e., learn about and monitor signs and symptoms). Get a blood test at least twice per year and whenever any changes are made have a blood test done around 1 month after.
- Optimizing hormones is a long journey. Starting anything with the potential for compounding growth sucks. It takes quite some time, effort, money, and experimentation to optimize and balance hormones. But it is worth it.
This point is worth repeating: do not just rely on blood tests -neither to “determine” a deficiency nor to “determine” efficacy of treatment! Furthermore, before starting any hormone therapy, make sure you thoroughly understand all the points outlined in Section 8 and you are aware of some of the general risks and side effects briefly touched upon in Section 10.
Step. 3: Replace individual hormones
I personally need -or choose- to optimize all hormones, but often, it is only one hormone that is deficient and for many people replacing that is sufficient. Furthermore, for different people, individual hormones might need to be adjusted based on biochemical differences, other conditions, or preferences.
For a summary and brief overview of the most prominent mental, behavioral, physical, physiological changes to be expected with the replacement of the different hormones, click here.
How to replace thyroid hormones. Click Here.
Summary: The thyroid is our largest endocrine gland. Thyroid hormones control the speed of metabolism in every cell of our body. Downstream, this affects everything from mood to energy levels, cognition, blood flow, metabolic health, etc. Therefore, a badly functioning thyroid gland has numerous adverse effects on every facet of our body, mind, and life. On the other hand, replacing thyroid hormones, if they are deficient, is a game-changer. As always, the greater the deficiency, the more prominent the changes will be!
How to replace male sex hormones (TRT). Click Here.
Summary: In males as well as in females, testosterone is the primary sex hormone. Testosterone has many effects on its own. Some additional effects are due to systemic and peripheral conversion of testosterone to estradiol (more important in females but also of major relevance in males), and dihydrotestosterone (more important in males with little importance in females). These sex steroids prime the body and brain for mating and reproduction. Testosterone is what makes males male. It improves masculinity in looks, physiology, and behavior. The greater the deficiency, the more prominent these changes will be!
How to replace female sex hormones (HRT). Click Here.
Summary: Sex steroids prime the body and brain for mating and reproduction. Estradiol is what makes females female. It improves femininity in looks, physiology, and behavior. Its effects are partially mediated in combination with testosterone and progesterone, all of which are needed for optimal health and wellbeing of a female human body. Too bad that post-menopause all three of these sex hormones fall to almost zero, causing millions of women around the world to live in a severe hormonal deficit for about half of their lives. For most females, HRT has fewer risks and side effects compared to living with low sex hormones -and yes, this does include mortality rates due to the powerful protective effects of the sex hormone against cardiovascular disease and neurodegeneration.
How to replace growth hormone/IGF1. Click Here.
Summary: The decrease in growth hormone (and IGF1) occurs linearly with age and parallels the degeneration of our body in terms of strength, agility, looks, function, health. Growth hormone should be better named “cell maintenance hormone” because it repairs just about everything in the body at the cellular level and therefore rejuvenates our whole body and mind. Replacing growth hormone can be compared to taking someone’s body to a repair-shop: A few months down the road, (s)he will look younger and feel more youthful. Our whole body will recover faster, we need less sleep, are calmer, have better cognition, and are more resilient -both physically and mentally. Generally, most people do well on (low-dose) GH-therapy unless they have low levels of cortisol. The lower IGF1 is at baseline, the greater the improvement will be.
How to replace cortisol & adrenals. Click Here.
Summary: Cortisol prepares the body and mind for action. It gives us energy, vitality, and “punch”. Cortisol clarifies our thinking, sharpens concentration, improves cognition and memory -all of which give us a “clear” head. Furthermore, cortisol provides plasma nutrients and regulates our immune system. Since cortisol levels are higher in times of stress, all of this makes physiological and evolutionary sense. Out of all the hormones, a cortisol deficiency causes us to feel the most miserable. It is also the hormone that has the quickest and most drastic improvement following its replacement. The greater the deficiency, the more significant the change will be. However, unfortunately, cortisol is the most complicated hormone, the hardest to figure out whether or not we are deficient, the most difficult to replace, and the most dangerous hormone in case of excess.
Other, non-major hormones that can be replaced
Note: This section is kept very short because these hormones are not part of the “major”, big four hypothalamic axes. For a more detailed discussion on these hormones, their science, benefits, practical aspects, and when and how to best replace them see here: “How To Replace Non-Major Hormones: An Ultimate Guide”
- Vitamin D: Vitamin D is a steroid hormone. It is synthesized in a complex cascade involving the skin, liver, and kidneys. It speeds up every aspect of calcium metabolism. Besides, it seems to have direct effects on the immune system (“sharper” immunity), central nervous system (mood, cognition), musculoskeletal system (stronger bones and muscles). Similar to melatonin, vitamin D is not a “supplement” but a powerful hormone. I have included it in the list of “supplements” I do recommend. See here.
- DHEA: DHEA is the most abundant hormone in our blood. It circulates in its sulfated form (DHEA-S) and has a long half-life. DHEA is a metabolic intermediate to sex hormones but can also exert some androgenic and estrogenic effects itself. Furthermore, it is also a neurosteroid and as such has effects independent of its androgenic and estrogenic effects. It decreases significantly with age.
- Pregnenolone: Pregnenolone is a precursor to all other steroid hormones. Furthermore, it also fulfills a role as a neurosteroid and as such it might improve mood and cognition, and memory.
- Progesterone: Unlike DHEA and pregnenolone, progesterone is not just a hormone precursor and a neurosteroid but also a “real” hormone itself (i.e. it has its own receptor). As a hormone, progesterone has a variety of important functions in the body, most of which are related to female reproduction. Furthermore, in the brain, progesterone itself is a neurosteroid, as well as a precursor to other neurosteroids. Of note, progesterone is the major precursor of the potent neurosteroid allopregnanolone, which has powerful calming effects.
- Melatonin: Melatonin entrains the circadian rhythm. Given in appropriate dosages (0.25–0.5mg) it improves every aspect of sleep (latency, depth, quality, SWS, REM, cortisol-awakening response, growth hormone release, etc.). However, at high doses (2mg or more) it inhibits all other hormonal axes (HPTA, HPA, HTA). On the other hand, both sex hormone and cortisol treatment will decrease melatonin secretion. (Melatonin is not a “supplement” but a hormone. But because most people regard it to be a supplement, I discuss it in much more detail here: Supplements everyone should take.)
- Aldosterone: Aldosterone is an adrenal steroid that mediates salt and fluid retention, which increases blood pressure. This reduces drowsiness, dizziness, and “brain fog” associated with low blood pressure and/or orthostatic hypotension. Furthermore, by stimulating sodium and fluid retention, aldosterone reduces the need to urinate frequently. Replacement of aldosterone (in the form of fludrocortisone) is useful in people with low blood pressure, orthostatic hypotension, excessive urination, and for people on glucocorticoid treatment.
- Oxytocin: Oxytocin is my favorite hormone. Oxytocin has been dubbed the “love hormone” because oxytocin levels surge when people fall in love. However, this is far from the whole story. Oxytocin acts as a hormone (i.e. via the bloodstream) but also as a neurotransmitter. As a hormone, oxytocin induces labor and stimulates milk let-down. As a neurotransmitter, oxytocin’s effects are highly complex and context-dependent. In most mammals, oxytocin is largely responsible for the mother-offspring bond, which in us humans also evolved to constitute the neurobiochemical program we call romantic love. However, in humans, oxytocin does not just strengthen parental and romantic but also social bonds. It increases trust and empathy and therefore mediates “bonding” between individuals. Furthermore, it increases the desire to be social, promotes prosocial behavior, makes people smile, and also enhances pleasure derived from social interaction. Oxytocin also leads to this “warm fuzzy feeling” when we give gifts. Furthermore, oxytocin improves libido and enhances pleasure from sex. Oxytocin’s main regulator is the hormone estradiol. Among other things, this is one reason why females are more emotional than males.
- ADH: Vasopressin is a neuro-hormone. Its main function is to regulate plasma osmolarity (solute concentration) by regulating the amount of water reabsorption by the kidneys. Low levels of vasopressin (diabetes insipidus) lead to excessive fluid loss via urination and unquenchable thirst.
- Insulin: Insulin is the most anabolic hormone in the human body. It increases growth of everything (e.g. muscle, fat, bones, organs, etc.). Out of all the hormones, insulin is -next to cortisol- by far the most dangerous hormone to replace -esp. in the long-term. The only difference is, that, unlike cortisol, exogenous replacement/supplementation does not carry the risk of permanent endogenous suppression. For a much more nuanced discussion on insulin, read here: A Diet That Works For Everyone. In this article, I discuss the science of insulin and its massive influence on our physiology.
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10. Risks and side effects
The risks and side effects of hormone therapy vary widely. For more details see the respective sections in the articles linked above. Here I will just briefly outline a few general points to keep in mind.
Replacing and balancing hormones to physiological and youthful levels has been done extensively by anti-aging specialists for decades. If done correctly, this is healthy, safe, and in most cases, the benefits outweigh the risks.
However, this does not hold if hormones approach high, unphysiological levels. Unfortunately, the overreplacement of any hormone is tempting because it might ”feel good” and/or mask other issues. However, over the long run, this carries more risks than benefits (e.g. increased rate of aging with thyroid overreplacement, body-wide catabolic effects with cortisol overreplacement, an increase in heart size and blood pressure with testosterone overreplacement, acromegaly with excessive doses of growth hormone, etc.). Therefore, with the over-replacement of any hormone -whether intentional or not, over the long run, we are likely trading off some health and longevity in the future for an increase in wellbeing and performance in the present. In my opinion, in most cases, this is a tradeoff not worth making.
Furthermore, in cases of severe overreplacement -whether intentional or not, the list of possible adverse effects is long and some of these can be severe and dangerous in both the short and/or long term.
For specific risks, signs, and consequences of excess, see the respective sections in the guides linked above.
In the same way that (partial) endocrine suppression happens over the first few weeks and months of treatment, so does the (complete) resumption of the endogenous endocrine function take time. Therefore, stopping any hormone therapy abruptly is almost always a bad idea and can lead to a host of adverse effects, depending on the hormone in question. For example, vital signs (blood pressure, pulse, body temperature) might be all over the place, water retention, insomnia, anorexia, nausea, wild mood swings (e.g. PMS-like symptoms). Personally, when I was stupid enough to stop thyroid treatment cold-turkey, I had a panic attack. If you want to know more about some of the lessons I learned from this experience, read here: Why depression is a chemical imbalance but not the way you think. Lessons from MDMA, bipolar disorder, self-experiments.
Note: While no hormone therapy should be stopped abruptly, the risk for severe adverse effects is greatest with the sudden cessation of thyroid therapy (if T3 makes up a substantial portion of the treatment) or cortisol therapy. In the worst-case scenario, this can lead to to myxedema coma and an adrenal crisis respectively. Both of these conditions can be life-threatening.
(Permanent) endocrine suppression
As mentioned earlier, thyroid medication is the most prescribed medication on the planet. The contraceptive is close behind. As long as normal doses are used, people almost always recover their baseline completely after a few months of stopping any hormone therapy.
In general, whenever hormones are introduced from the outside, there is some suppression of endogenous hormone secretion. Usually, this endocrine suppression is just partial (e.g. 40%) and temporary (i.e. it persists only as long as exogenous hormones are present). Given that physiological dosages are used (and tapering off is done correctly), most people will gradually return to their baseline values within a few weeks to months after stopping treatment (or to even higher levels if the cause for their hormone deficiency was found and removed).
If an individuals’ hypothalamus and pituitary gland are not healthy, plastic, resilient enough, but rather “weak” (for whatever reason), complete endocrine suppression is a possibility even if small, physiological doses are used (e.g. LH/FSH, TSH, ACTH fall to unmeasurable levels despite the target hormone being well in range and despite no signs and symptoms of over-replacement). Most people recover even from complete endocrine suppression (although recovery takes longer).
However, it is possible that someone does not bounce back to their baseline and the endocrine suppression remains permanent. The scientific mechanism behind this is twofold.
- Firstly, there are epigenetic adaptations at the level of the hypothalamus in individual cells associated with hormone monitoring and secretion.
- Secondly, there are neuroplastic changes at the network level within the hypothalamus, permanently turning the hormonal pulse-generators and feedback machinery down or even off.
While this is very rare and applies almost exclusively to people who were (ab)using hormones at very high doses and for an extended period of time (e.g. users of anabolic steroids), it could happen, in which case hormone replacement needs to be continued for life.
11. Will I have to continue hormone treatment for life?
Perhaps one of the most feared consequences of hormone interventions is the possibility of becoming dependent on it for life. If the cause of the hormone deficiency can be found and corrected, hormone therapy can be temporary. This is usually the case for around half the people. The other half will likely keep replacing their hormone(s) for a long time (potentially for life) because, in this half, one of three scenarios applies.
- Firstly, no cause can be found (or a cause can be found but cannot be removed) and people decide for themselves that the risks and downsides of living with one or more deficient hormones are greater than the risks and downsides of continuing hormone therapy.
- Secondly, a cause can be found and removed and hormones are somewhat improved but after having seen life on the other side, many people do not even want to go back.
- Thirdly, very rarely, repeated tapering attempts are unsuccessful, and coming off is not even an option anymore because of permanent endocrine suppression.
Usually, the greatest “risk” is with the second scenario, which is not so much about being unable to get back to baseline, but rather with having seen the other side and not wanting to go back. Even though this does not sound like a real “risk”, this can be a real issue. For example, if someone is not able to afford or procure therapy anymore or if any medical issues arise that forbid a continuation of therapy.
For example, scenario #2 applies to my parents: As menopause set in, my mum became more and more lethargic and passive with a waning interest in friends and hobbies. Similar things for my dad as he approached his fifties. Having experienced the powerful and destructive forces of hormones in my own life, I put both of them on hormone replacement therapy. Thyroid and various sex hormones for my mum (topical estradiol, oral progesterone, DHEA) and testosterone plus a small dose of growth hormone for my dad. They were reminded of how it felt like when they were young. How much more energy they had, how much more motivated they were to do things. How much better their sleep used to be, feeling refreshed right after waking up. All in all, how much better and easier life can be if you are very vital all the time. It also struck them how much life enjoyment and opportunities they had forfeited all these years by just feeling mediocre. Even though it required some convincing (esp. for my mum), now they are glad they went for hormone optimization. For example, my mum’s skin and hair became more youthful (a big one for her), her cheerful nature slowly came back, better sleep, interest in friends and hobbies reemerged. In fact, HRT has given her “her life back”. A life she has been missing for years. She even draws a line and divides her life into “pre-treatment” and “post-treatment”-days.
It is easy to get used to the benefits.
When people try to beat cancer, this is their only problem. They regret what they cared about when life was normal. They wish they just had all the petty problems others have. Health might not be everything, but without it, everything is nothing. After winning the war, what usually follows is a period of utter bliss. Perhaps one needs to have seen the darkness to really appreciate the light. However, because it is deceptively easy to get used to any change that is permanent, this gratitude does not last and soon, groundhog day sets in again. People fall into the same old habits, their brains default-mode, and they again start to take their regained health for granted.
While I do not want to compare my former state to cancer, the sequence I went through bears some resemblance. In the first few months after starting therapy and having been brought back from the living dead, I was indescribably grateful (words are useless here). I was moved to tears multiple times every day. However, within a year or so, I got almost completely used to my new, reversely self-engineered vitality.
For many people on hormone replacement, something similar happens. They have been living with one or more deficient hormones for a long time and then start to replace what was missing. In the first few months, people are often incredibly grateful to have been given “their life back” and, initially, they consider the costs, side effects, and downsides of therapy a tiny price to pay. However, after some time, many tend to take their improved energy, mood, sleep, motivation, emotional wellbeing, looks, etc. for granted and they soon tend to forget how things were before.
This can go so far that now, suddenly, the nuisances associated with therapy (e.g. pills, injections, costs, traveling) seem to outweigh the benefits, simply because they utterly forgot how life used to be before. Therefore, before starting therapy, we should write down our symptoms, how we feel and what our life is like. This will later be a helpful reminder in case we question whether hormone therapy takes more than it gives.
Whenever I catch myself taking my (new) vitality for granted (and esp. whenever any of this feels like a nuisance), from time to time, I leave out the cortisol for a day or so. I guess most of you do not know what it feels like to live without any significant amount of cortisol in your system. The effects on how I feel are instant (unlike with any other hormone). So, these occasional days of “feeling like crap” give me a glimpse of how I felt in the past and show me over and over again how hormone optimization has given me a new life, rekindling my gratitude, often for weeks. It also reminds me of how small the price is I pay for the reward I get. However, these reminders also bring out compassion and sadness about the suffering and lost opportunities by millions of people around the world. People who were not as lucky as I have been. People who are unaware of the forces pulling the strings in the background.
On butterflies, upwards spirals, and the most powerful force in the universe.
Our world is a highly chaotic system. If you alter starting conditions even just slightly, the trajectory and outcome might be totally different. This is called the butterfly effect.
Let’s embark on a thought experiment. Let’s clone the universe. Now you and a biological clone exist, who is exactly identical to you down to the atomic level -identical health, mind, thoughts, life. Then, in the parallel universe, a vicious scientist secretly injects your clone with testosterone every night while the clone is sleeping.
The scientist then keeps track of the changes in your life versus the life of your clone. There is no sure way to tell how the experiment will go, but for sure, your alternate futures will be very different. The longer the experiment runs, the larger the differences will be.
He has a little more energy right after waking up, is more optimistic about starting a new day. He needs 30min less sleep, 15 of which he then uses for the morning meditation real-you never has the time and energy for.
Cloned-you is not chronically lethargic anymore. Therefore, he is able to use the afternoon lulls you experience in new and productive ways.
He has more drive to do things, procrastinates less, is more motivated to study. Instead of browsing Reddit, cloned-you feels motivated enough to finally start that business you’ve always had in the back of your mind.
He is not as tired anymore but more “present”. Also, he can finally apply some of what he has read in all these self-help books because he now has the needed energy for it.
Thanks to the combined improvements in energy levels, drive, and motivation your clone’s willpower increases, which allows him to make better food choices, exercise more, and improve his sleeping habits.
He has an easier time losing fat and building muscle. This causes him to look better, which makes him react with more self-confidence towards others and causes others to react with more benevolence towards him. The gains in looks (along with the energy, mood, enthusiasm) translate into a more fulfilling social life.
Because of the many direct and indirect effects of testosterone, he is also in a better mood than you, which does not only affect his own wellbeing but also how much people like being around him because mood is contagious. He has more friends and better relationships, which also yield some valuable life opportunities offered to him by his social circle.
Because of his better social relationships, higher social status, and his improved ability to work hard, he also earns more money and his wealth becomes much greater than yours.
The increase in self-confidence and motivation makes it easier for him to go out of his comfort zone more often. One time, he gets over the hump and talks to Isabella, a woman he was blown away by from the first second he saw her. Down the road, she becomes his wife, which would not have happened if he did not have the courage to talk to her that day.
We could continue this ad nauseam.
Having seen the evolution of their lives, if you could choose which life to have lived, would you choose your life or your clone’s?
Initial change might be slow, but years down the road the greater energy, mood, health, etc. lead to an upwards spiral in many domains of your clone’s life. An upwards spiral real-you stands no chance of catching up with.
Even if cloned-you gets just a very small amount of additional value every day, over time this does add up. And whether cloned-you is aware of it or not, he automatically reinvests this daily compounded interest anew, every single day. Day after day. 365 days a year.
For the sake of argument let’s arbitrarily assume that cloned-you is able to grow an additional 0.1% per day compared to real-you. (0.1% is quite a conservative estimate considering the large ripple effects of improved energy, mood, health on all domains of life.)
After one year, cloned-you is 45% ahead. After 5 years, 619% and after 10 years a whopping 3840%. Of course, this is unrealistic and asymptotes will eventually be approached, but this is simply illustrating that there is a reason why Einstein called compound growth the most powerful force in the universe.
In the past, the fact that I replaced many of my hormones was a kink in my story, something I was not proud of and it even made me feel somewhat ashamed. I tried to hide it from others. After I have been doing this for a few years, I came to terms with being my own bio-engineer. I simply have no other choice. Without it, I do not know where I would be right now. Would I be seriously depressed? Would I have turned to drugs because at one point I just could not “push through” anymore? I do not know the answer to these questions, but for sure I would not be here writing this.
In just a few years of optimizing my hormones, my outer and inner life radically changed. I started to dream again. I found purpose. I found something I want to contribute. I now also have the necessary energy, mood, and health to keep working on my dreams, to enjoy working on my dreams.
Many fail not because their dreams do not work out but simply because they have no energy left to burn long enough for their dreams to bear fruit.
How different would the world be had these young enthusiastic founders just had enough energy to keep burning? How many Bill Gates’ did not make it because their failing biology put a padlock in front of their dreams? How many Elon Musk’s did not even begin to make the world a better place because they did not have the necessary vitality to start their endeavor? To even start to dream in the first place?
People need to know that there are invisible biological shackles many of us carry. Shackles that make it much harder to live a life we like. Shackles that make it harder to dream, to find purpose, and certainly much harder to have the necessary persistence, drive, energy, and health to keep working towards it.
Optimizing my biology has been my main focus for about three years, during which it was my main driving force, my purpose. Everything else was secondary. Now, from a biological perspective, for me, there is not (that) much left to optimize. My reversely engineered vitality will help me with whatever else I want to do in life. And I know what I want to do. I want to point people in the right direction towards removing these biological shackles. I want to help others to improve their vitality in a similar way I bio-engineered mine. Help others to enjoy their life more fully. Help others to work on whatever is their purpose (making it my “meta”-purpose, if you will), hopefully advancing humanity and increasing the wellbeing of other fellow humans.
This short guide took years of studying, researching, blood tests, experimentation, side effects. Had I known then what I know now, it would have spared me a vast amount of time, effort, money, and suffering. I hope sharing what I have learned can help some of you.
When it comes to hormones, the right or wrong choice can make or break your life. Due to my unique story, extensive knowledge, and personal experience, few people know as much about hormones, all their interactions, and specifics. Using individualized hormone optimization, lifestyle changes, diet, supplements, and sometimes pharmaceutical drugs, I have worked with hundreds of people around the world and was able to solve diverse problems such as chronic fatigue, fibromyalgia, brain fog, libido issues, anhedonia, depression, anxiety, ADHD, body recomposition, fixing metabolism after a starvation diet, infertility, resetting the HPA-axis to a higher setpoint, reversing thyroid resistance, multiple hormone balancing, etc. My goal is not to just patch up symptoms (as most doctors do) but to holistically understand a case with its history, health, situation, and context. For inquiring about your own situation, contact: firstname.lastname@example.org
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